Hot Off the Press: A Systematic Review And Meta‐analysis of Ketamine as an Alternative to Opioids for Acute Pain in the Emergency Department

Heitz, Corey; Morgenstern, Justin; Bond, Christopher; Milne, William K.

doi:10.1111/acem.13658

Cited by 3 publications

(1 citation statement)

References 4 publications

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“…19 To mitigate these outcomes, EDs are increasingly using alternatives to opioids to treat painful conditions. [20][21][22] If and how urgent care centers are implementing similar pain management strategies should be examined. There may be an opportunity to reduce opioid prescribing in urgent care settings and to expand the use of nonopioid analgesics for pain management.…”

Section: Discussionmentioning

confidence: 99%

Association Between In-Clinic Opioid Administration and Discharge Opioid Prescription in Urgent Care: a Retrospective Cohort Study

et al. 2020

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BACKGROUND: Emergency departments increasingly use nonopioid analgesics to manage acute pain and minimize opioid-related harms. Urgent care centers are expanding to lower costs and provide efficient access to healthcare. General internists increasingly work in these acute care settings. Much is known about opioid prescribing in the primary care, inpatient, and emergency department setting. Little is known about opioid prescribing in the urgent care setting and associated outcomes. OBJECTIVES: To assess the association between in-clinic opioid administration and opioid receipt at clinic discharge and on progression to chronic opioid use among urgent care patients. DESIGN: Retrospective cohort study. PARTICIPANTS: Patients, 20 years or older and not on opioid medications, who presented for care to an urgent care clinic within a safety-net healthcare system from June 1, 2016, to April 30, 2019. MAIN MEASURES: We examined the association between the in-clinic administration of oral or intravenous opioids and opioid receipt at clinic discharge. We also examined the association between in-clinic opioid administration and progression to chronic opioid use after six months. KEY RESULTS: The study sample included 34,978 patients, of which 13.8% (n = 4842) received in-clinic opioids and 86.2% (n = 30,136) did not receive in-clinic opioids. After adjusting for age, gender, race/ethnicity, insurance, and pain diagnosis, patients who received in-clinic opioids were more likely to receive opioids at discharge compared to patients who did not receive in-clinic opioids (aOR = 12.30,). Among a selected cohort of patients, in-clinic opioid administration was associated with progression to chronic opioid use (aOR = 2.12, 95% CI 1.66-2.71). CONCLUSIONS: In-clinic opioid administration was strongly associated with opioid receipt at discharge and progression to chronic opioid use. Increased use of nonopioid analgesics in urgent care could likely reduce this association and limit opioids available for diversion, overdose, and death.

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Section: Discussionmentioning

confidence: 99%

Association Between In-Clinic Opioid Administration and Discharge Opioid Prescription in Urgent Care: a Retrospective Cohort Study

et al. 2020

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Prehospital Use of Ketamine in the Combat Setting: A Sub-Analysis of Patients With Head Injuries Evaluated in the Prospective Life Saving Intervention Study

et al. 2020

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Objectives Ketamine is used as an analgesic for combat injuries. Ketamine may worsen brain injury, but new studies suggest neuroprotection. Our objective was to report the outcomes of combat casualties with traumatic brain injury (TBI) who received prehospital ketamine. Methods This was a post hoc, sub-analysis of a larger prospective, multicenter study (the Life Saving Intervention study [LSI]) evaluating prehospital interventions performed in Afghanistan. A DoD Trauma Registry query provided disposition at discharge and outcomes to be linked with the LSI data. Results For this study, we enrolled casualties that were suspected to have TBI (n = 160). Most were 26-year-old males (98%) with explosion-related injuries (66%), a median injury severity score of 12, and 5% mortality. Fifty-seven percent (n = 91) received an analgesic, 29% (n = 46) ketamine, 28% (n = 45) other analgesic (OA), and 43% (n = 69) no analgesic (NA). The ketamine group had more pelvic injuries (P = 0.0302) and tourniquets (P = 0.0041) compared to OA. In comparison to NA, the ketamine group was more severely injured and more likely to require LSI procedures, yet, had similar vital signs at admission and disposition at discharge. Conclusions We found that combat casualties with suspected TBI that received prehospital ketamine had similar outcomes to those that received OAs or NAs despite injury differences.

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A systematic review and meta-analysis comparing the efficacy and safety of ketamine versus morphine for the treatment of acute pain

SONG,

WANG,

CHEN

2024

Minerva Anestesiol

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Hot Off the Press: A Systematic Review And Meta‐analysis of Ketamine as an Alternative to Opioids for Acute Pain in the Emergency Department

Cited by 3 publications

References 4 publications

Association Between In-Clinic Opioid Administration and Discharge Opioid Prescription in Urgent Care: a Retrospective Cohort Study

Association Between In-Clinic Opioid Administration and Discharge Opioid Prescription in Urgent Care: a Retrospective Cohort Study

Prehospital Use of Ketamine in the Combat Setting: A Sub-Analysis of Patients With Head Injuries Evaluated in the Prospective Life Saving Intervention Study

A systematic review and meta-analysis comparing the efficacy and safety of ketamine versus morphine for the treatment of acute pain

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