Intranasal ketamine for acute traumatic pain in the Emergency Department: a prospective, randomized clinical trial of efficacy and safety

Abstract

BackgroundKetamine has been well studied for its efficacy as an analgesic agent. However, intranasal (IN) administration of ketamine has only recently been studied in the emergency setting. The objective of this study was to elucidate the efficacy and adverse effects of a sub-dissociative dose of IN Ketamine compared to IV and IM morphine.MethodsA single-center, randomized, prospective, parallel clinical trial of efficacy and safety of IN ketamine compared to IV and IM morphine for analgesia in the emergency department (ED). A convenience sample of 90 patients aged 18–70 experiencing moderate-severe acute traumatic pain (≥80 mm on 100 mm Visual Analog Scale [VAS]) were randomized to receive either 1.0 mg/kg IN ketamine, 0.1 mg/kg IV MO or 0.15 mg/kg IM MO. Pain relief and adverse effects were recorded for 1 h post-administration. The primary outcome was efficacy of IN ketamine compared to IV and IM MO, measured by “time-to-onset” (defined as a ≥15 mm pain decrease on VAS), as well as time to and degree of maximal pain reduction.ResultsThe 3 study groups showed a highly significant, similar maximal pain reduction of 56 ± 26 mm for IN Ketamine, and 59 ± 22 and 48 ± 30 for IV MO and IM MO, respectively. IN Ketamine provided clinically-comparable results to those of IV MO with regards to time to onset (14.3 ± 11.2 v. 8.9 ± 5.6 min, respectively) as well as in time to maximal pain reduction (40.4 ± 16.3) versus (33.4 ± 18), respectively.ConclusionsIN ketamine shows efficacy and safety comparable to IV and IM MO. Given the benefits of this mode of analgesia in emergencies, it should be further studied for potential clinical applications.Trial registrationRetrospectively registered on 27 June 2016. ClinicalTrials.gov ID: NCT02817477 Electronic supplementary materialThe online version of this article (doi:10.1186/s12873-016-0107-0) contains supplementary material, which is available to authorized users.

Pharmacokinetics, absolute bioavailability and tolerability of ketamine after intranasal administration to dexmedetomidine sedated dogs

“…These reactions may be due to the bitter taste of ketamine, which could have caused irritation and an unpleasant sensation in the dogs. In human medicine, patients receiving intranasal ketamine frequently complain about a bad taste in the mouth, due to drug runoff into the pharynx [6,9,13,59].…”

“…In addition, intranasal drug delivery avoids painful parenteral administration. Intranasal ketamine has been successfully used for sedation and premedication of pediatric patients [5][6][7] and in pain management of both children and adults [8][9][10][11][12][13]. Another application lies in psychiatry, where intranasal ketamine has been shown to be safe and effective for the treatment of major depressive disorders [14][15][16].…”

Anesthesia and Analgesia In War and Terror Injuries

“…Ketamin, tek başına veya geleneksel opioidlerle birlikte etkindir. Damar yolu sağlanamamış hastalarda intranasal ketamin de yeğlenebilir (41) . HKA ağrı kontrolü için iyi bilinen bir tekniktir.…”

Efficacy and Safety of Morphine and Low Dose Ketamine for Pain Control of Patients with Long Bone Fractures: A Randomized, Double-Blind, Clinical Trial

“…At high doses drug causes hallucination, disturbed sleep, increased intracranial pressure, high blood pressure, tachycardia, and tonic-clonic seizure [7]. Several studies have shown that ketamine is effective agent in the treatment of pain [8] and morphine is the most commonly used analgesic in emergency centers [5,[9][10][11][12][13][14][15][16]. Intravenous ketamine is an available agent associated with minimal complications and side effects while the morphine is less available and associated with several side effects such as tolerance [10][11][12][13].…”