Intranasal ketamine for the treatment of patients with acute pain in the emergency department

Abstract

BACKGROUND: Pain in the emergency department (ED) is common but undertreated. The objective of this study was to examine the effi cacy and safety of intranasal (IN) ketamine used as an analgesic for patients with acute injury with moderate to severe pain. METHODS:This study was a cross sectional, observational study of patients more than 8 years old experiencing moderate to severe pain [visual analog score (VAS) >50 mm]. The initial dose of IN ketamine was 0.7 mg/kg with an additional dose of 0.3 mg/kg if VAS was more than 50 mm after 15 minutes. Pain scores and vital signs were recorded at 0, 15, 30 and 60 minutes. Side-effects, sedation level and patient's satisfaction were also recorded. The primary outcome was the number of patients achieving ≥ 20 mm reductions in VAS at 15 minutes. Other secondary outcome measures were median reduction in VAS at 15, 30 and 60 minutes, changes of vital signs, adverse events, satisfaction of patients, and need for additional ketamine. RESULTS:Thirty-four patients with a median age of 29.5 years (IQR 17.5-38) were enrolled, and they had an initial median VAS of 80 mm (IQR 67-90). The VAS decreased more than 20 mm at 15 minutes in 27 (80%) patients. The reduction of VAS from baseline to 40 mm and 20 mm respectively at 15, 30 and 60 minutes (P<0.001). No critical changes of vital signs were noted and adverse effects were mild and transient. CONCLUSION:This study showed that IN ketamine is an analgesic choice for patients with acute injury in moderate to severe pain in an overcrowded and resource limited ED.

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

“…Even though there are multiple observation trials studying ketamine, the literature supporting it as an alternative to opioids for the management of acute pain is limited by the low quality of study design and small numbers of studies, although newer studies are overcoming these issues . In many instances, the inclusion criteria were either very broad and included patients that probably should not have received either an opioid or ketamine or compared ketamine to a placebo, a questionable study design considering we have effective analgesics .…”

Intranasal Ketamine vs. Intramuscular Pethidine in Labor Pain Analgesia

“…Andolfatto G, et al [15] used Intranasal ketamine for analgesia in the emergency department in a study and have reached a conclusion that intranasal ketamine lowered VAS pain scores to a clinically significant degree in 88% of emergency department (ED) patients Also Roshana S, et al [16] tried intranasal ketamine for the treatment of patients with acute pain in the ED and concluded that intranasal ketamine is an analgesic choice for acute injury patients with moderate to severe pain especially in an overcrowded and resource limited ED.…”

Transmission pathways and mediators as the basis for clinical pharmacology of pain

“…Ketamine safety has been probed in a variety of clinical studies. One study that evaluated intranasal ketamine for pain control in an emergency department setting cited concerns about ketamine safety [83]. The study concluded that, based on a visual analog pain score, most of the study subjects received pain relief from the ketamine [83].…”

“…One study that evaluated intranasal ketamine for pain control in an emergency department setting cited concerns about ketamine safety [83]. The study concluded that, based on a visual analog pain score, most of the study subjects received pain relief from the ketamine [83]. At the same time, they noted only mild or transient side effects in this population [83].…”

“…The study concluded that, based on a visual analog pain score, most of the study subjects received pain relief from the ketamine [83]. At the same time, they noted only mild or transient side effects in this population [83]. …”