Comparison of efficacy of nebulized ketamine with morphine and intravenous morphine in pain reduction in patients with traumatic long-bone fractures admitted to emergency department

Azizkhani, Reza; Akhbari, Kourosh; Masoumi, Babak; Parna, Abdolrahman; Golshani, Keihan

doi:10.4103/atr.atr_13_18

Cited by 2 publications

(15 citation statements)

References 27 publications

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“…All studies administered a single predefined dose of adjuvant S-ketamine at the start of the study, however doses and routes of administration varied between studies; adjuvant SDK was administered intravenously in six studies, 17 39 40 42 44 45 intranasally in one study 43 and by inhalation in one study. 41 Adjuvant SDK doses administered intravenously varied between 0.1 mg/kg 17 and 0.3 mg/kg. 40 44 45 Adjuvant SDK doses administered by intranasal (IN) and inhalation routes were 1.0 mg/kg 43 and 1.5 mg/kg, respectively.…”

Section: Resultsmentioning

confidence: 99%

“… 40 44 45 Adjuvant SDK doses administered by intranasal (IN) and inhalation routes were 1.0 mg/kg 43 and 1.5 mg/kg, respectively. 41 Based on bioavailability of IN (25%–50%) 46 and nebulised (inhaled) (20%–40%) 47 48 ketamine, the systemic absorption for 1.0 mg/kg IN and 1.5 mg/kg nebulised ketamine would approximate 0.25–0.5 mg/kg and 0.3–0.6 mg/kg intravenous (IV) ketamine, respectively. Doses and routes of morphine administration also varied; six studies administered 0.1 mg/kg, 39–42 44 45 one study administered 0.05 mg/kg 43 and one study administered provider-determined morphine or equivalent doses.…”

Section: Resultsmentioning

confidence: 99%

“… 17 In seven studies, repeat doses of morphine or equivalent were administered intermittently until a specific pain threshold was reached; 17 39 40 42–45 one study administered a single dose of morphine and excluded patients that required rescue analgesia. 41 Detailed information on included studies is provided in online supplemental appendix 1 .…”

Section: Resultsmentioning

confidence: 99%

“…A sensitivity analysis was conducted omitting Bowers et al 17 and Azizkhani et al 41 since study protocols differed significantly from the remaining studies. After omission, significant differences in mean pain intensity scores favouring adjuvant SDK were observed >15–30 min (MD −1.09; 95% CI −1.78 to −0.39) and 60 min (MD −0.78; 95% CI −1.32 to −0.24), after study drug administration ( figure 3 and table 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…All included studies were published between 2014 and 2020 (table 1). Five studies were conducted in Iran [39][40][41][42][43] and three were from the USA. 17 44 45 A total of 903 patients were randomised to treatment arms; of which 897 patients were included in formal analyses (69.1% were male; 485 were assigned to intervention and 412 to control).…”

Section: Study and Patient Characteristicsmentioning

confidence: 99%

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Subanaesthetic single-dose ketamine as an adjunct to opioid analgesics for acute pain management in the emergency department: a systematic review and meta-analysis

Galili

Nikolajsen

Papadomanolakis-Pakis

2023

BMJ Open

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ObjectiveTo evaluate the effectiveness of a subanaesthetic single-dose ketamine (SDK) as an adjunct to opioids for acute pain in emergency department (ED) settings.DesignSystematic review and meta-analysis.MethodsA systematic search was performed in MEDLINE, Embase, Scopus and Web of Science through March 2022. Randomised controlled trials (RCTs) that investigated SDK as an adjunct to opioids in adult patients for any painful condition in ED settings were selected. Two reviewers screened studies, extracted data and assessed study quality. Data were pooled using random-effects models. The primary outcome was mean pain intensity score measured at baseline, >0–15 min, >15–30 min, >30–45 min, 60 min, 90 min and 120 min. Secondary outcomes included need for rescue analgesia, adverse events and patient satisfaction. Results were reported as mean differences (MDs) and risk ratios. Statistical heterogeneity was calculated using theI2statistic.ResultsEight RCTs were included (n=903). Studies were judged to be at moderate to high risk of bias. Mean pain intensity scores were significantly lower 60 min after study drug administration favouring adjuvant SDK (MD −0.76; 95% CI −1.19 to −0.33), compared with opioids alone. There was no evidence of differences in mean pain intensity scores at any other time point. Patients who received adjuvant SDK were less likely to require rescue analgesia, no more likely to experience serious side effects and had higher satisfaction scores, compared with opioids alone.ConclusionsAvailable evidence suggests adjuvant SDK can have an effect on lowering pain intensity scores. Although reduction of pain scores was not clinically significant, the combination of reduced pain intensity and reduced opioid requirements suggest the results could be clinically important and support the potential utility of SDK as an adjunct to opioids to treat acute pain in adult ED patients. However, current evidence is limited and higher quality RCTs are needed.PROSPERO registration numberCRD42021276708.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Study and Patient Characteristicsmentioning

confidence: 99%

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Subanaesthetic single-dose ketamine as an adjunct to opioid analgesics for acute pain management in the emergency department: a systematic review and meta-analysis

Galili

Nikolajsen

Papadomanolakis-Pakis

2023

BMJ Open

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Continued Opioid Use and Adverse Events Following Provision of Opioids for Musculoskeletal Pain in the Emergency Department: A Systematic Review and Meta-Analysis

Chen,

Maher,

Han

et al. 2023

Drugs

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Background The prevalence of continued opioid use or serious adverse events (SAEs) following opioid therapy in the emergency department (ED) for musculoskeletal pain is unclear. The aim of this review was to examine the prevalence of continued opioid use and serious adverse events (SAEs) following the provision of opioids for musculoskeletal pain in the emergency department (ED) or at discharge. Methods Records were searched from MEDLINE, EMBASE and CINAHL from inception to 7 October 2022. We included randomised controlled trials and observational studies enrolling adult patients with musculoskeletal pain who were administered and/or prescribed opioids in the ED. Continued opioid use and opioid misuse data after day 4 since ED discharge were extracted. Adverse events were coded using the Common Terminology Criteria for Adverse Events (CTCAE), and those rated as grades 3–4 (severe or life-threatening) and grade 5 (death) were considered SAEs. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Results Seventy-two studies were included. Among opioid-naïve patients who received an opioid prescription, 6.8–7.0% reported recent opioid use at 3–12 months after discharge, 4.4% filled ≥ 5 opioid prescriptions and 3.1% filled > 90-day supply of opioids within 6 months. The prevalence of SAEs was 0.02% [95% confidence interval (CI) 0, 0.2%] in the ED and 0.1% (95% CI 0, 1.5%) within 2 days. One study observed 42.9% of patients misused opioids within 30 days after discharge. Conclusions Around 7% of opioid-naïve patients with musculoskeletal pain receiving opioid therapy continue opioid use at 3–12 months after ED discharge. SAEs following ED administration of an opioid were uncommon; however, studies only monitored patients for 2 days. Protocol Registration 10.31219/osf.io/w4z3u. Supplementary Information The online version contains supplementary material available at 10.1007/s40265-023-01941-1.

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Comparison of efficacy of nebulized ketamine with morphine and intravenous morphine in pain reduction in patients with traumatic long-bone fractures admitted to emergency department

Cited by 2 publications

References 27 publications

Subanaesthetic single-dose ketamine as an adjunct to opioid analgesics for acute pain management in the emergency department: a systematic review and meta-analysis

Subanaesthetic single-dose ketamine as an adjunct to opioid analgesics for acute pain management in the emergency department: a systematic review and meta-analysis

Continued Opioid Use and Adverse Events Following Provision of Opioids for Musculoskeletal Pain in the Emergency Department: A Systematic Review and Meta-Analysis

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