A Systematic Review and Meta‐analysis of Ketamine as an Alternative to Opioids for Acute Pain in the Emergency Department

Karlow, Nicholas; Schlaepfer, Charles; Stoll, C; Doering, Michelle; Carpenter, Christopher R.; Colditz, Graham A.; Motov, Sergey; Miller, J P; Schwarz, Evan S.

doi:10.1111/acem.13502

Cited by 77 publications

(70 citation statements)

References 54 publications

(61 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In a similar vein, take‐home naloxone can be co‐prescribed to reduce the risk of overdose mortality . Evocative treatments, such as ketamine, have even begun to permeate into the emergency management of acute pain and may prevent the initiation of opioid prescribing .…”

mentioning

confidence: 99%

Commentary on Hayes et al. (2020): The harms of opioid dose escalation in the management of chronic non‐cancer pain

Bahji

2020

Addiction

View full text Add to dashboard Cite

mentioning

confidence: 99%

Commentary on Hayes et al. (2020): The harms of opioid dose escalation in the management of chronic non‐cancer pain

Bahji

2020

Addiction

View full text Add to dashboard Cite

“…Clinical data are consistent with analgesic benefits of NMDAR antagonists for neuropathic pain 1 , CRPS 1,8 , acute pain in the emergency room 15 , and a reduced requirement for opiods 4 .…”

Section: Introductionmentioning

confidence: 56%

NMDA receptor antagonists and pain relief

et al. 2019

View full text Add to dashboard Cite

ObjectiveWe conducted a meta-analysis of controlled trials that used experimental models of acute pain and hyperalgesia to examine the analgesic effects of NMDA receptor (NMDAR) antagonists.MethodsSix major databases were systematically searched (to March 2018) for studies using human evoked pain models to compare NMDAR antagonists with no-intervention controls. Pain outcome data were analyzed with random-effects meta-analysis.ResultsSearches identified 70 eligible trials (n = 1,069). Meta-analysis found that low-dose ketamine (<1 mg/kg) produced a decrease in hyperalgesic area (standardized mean difference 0.54, 95% confidence interval [CI] 0.34, 0.74, p < 0.001) and a 1.2-point decrease (95% CI 0.88, 1.44, p < 0.001) in pain ratings from 4.6 to 3.4 on a 0–10 scale (a 26% reduction). Similar analgesia was observed for acute and hyperalgesic models and was constant across the dosing range (0.03–1.00 mg/kg). Moderate to high variability in effect size was observed and mild side effects (e.g., sedation, sensory disturbance) were common. No effects of dextromethorphan were found.ConclusionsFindings provide robust evidence for analgesic and antihyperalgesic effects of ketamine, supporting its utility for acute and chronic pain management. However, pain relief was modest, suggesting ketamine may potentially be most useful when opioids are contraindicated, rapid analgesia is required, or for pain resistant to conventional medication.

show abstract

“…The use of ketamine as an alternative for the acute exacerbation of chronic pain related to malignant disease was reviewed and ketamine although ketamine was effective, the authors concluded that more randomized controlled studies were needed [25]. A comprehensive systematic review and meta-analysis of randomized controlled trials compared intravenous opioid analgesics to low-dose ketamine for relief of acute pain in the emergency department and concluded that ketamine is not inferior to morphine and was a viable alternative to opioids in the emergency department [28]. A prospective, randomized, double-blind trial held in an emergency department for patients from the age of 18 -55 that suffered acute, moderate to severe, abdominal, flank and musculoskeletal pain found that sub-dissociative doses of ketamine were successful in treating pain in comparison to intravenous morphine with a confidence index of 95% and P < 0.05 denoting statistical significance [21].…”

Section: Comparison In the Reduction Of Acute Painmentioning

confidence: 99%

“…The need for opioids such as morphine may be reduced by 26% -60% when ketamine is used as an adjunct [30]. Non-severe adverse effects that need to be monitored and treated due to low dose ketamine include nausea, dizziness, drowsiness, vomiting, decreased oxygen saturation [19] [28]. Opioids such as morphine also have similar non-severe adverse effects [19] [28], but their use also worsens the opioid epidemic [2] [14].…”

Section: Considerations For Practitioners and Nursesmentioning

confidence: 99%

Low Dose Ketamine Used for Acute Pain Management in the Emergency Department

Kestenian¹,

Gantioque²,

Snyder³

2020

OJEM

View full text Add to dashboard Cite

The use of opioid analgesics has created an opioid addiction epidemic in the United States and around the world. One of the main responsibilities of the emergency department is to address acute pain. In this paper we examine the use of low dose ketamine as a safe substitute for opioid analgesics. Types of pain are identified using prior established taxonomy, followed by discussing types of management and treatments. The opioid epidemic and its societal implications are considered. We also examine the side effects of ketamine and the use of ketamine as an adjunct to analgesics used for pain control. Recommendations and considerations for the use of ketamine are suggested, and a low dose ketamine administration sample hospital policy is reviewed.

show abstract

A Systematic Review and Meta‐analysis of Ketamine as an Alternative to Opioids for Acute Pain in the Emergency Department

Abstract: Ketamine is noninferior to morphine for the control of acute pain, indicating that ketamine can be considered as an alternative to opioids for ED short-term pain control.

Cited by 77 publications

References 54 publications

Commentary on Hayes et al. (2020): The harms of opioid dose escalation in the management of chronic non‐cancer pain

Commentary on Hayes et al. (2020): The harms of opioid dose escalation in the management of chronic non‐cancer pain

NMDA receptor antagonists and pain relief

Low Dose Ketamine Used for Acute Pain Management in the Emergency Department

Contact Info

Product

Resources

About