Intravenous Subdissociative-Dose Ketamine Versus Morphine for Analgesia in the Emergency Department: A Randomized Controlled Trial

Motov, Sergey; Rockoff, Bradley; Cohen, Victor; Pushkar, Illya; Likourezos, Antonios; McKay, Courtney; Soleyman-Zomalan, Emil; Homel, Peter; Terentiev, Victoria; Fromm, Christian

doi:10.1016/j.annemergmed.2015.03.004

Cited by 117 publications

(111 citation statements)

References 27 publications

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“…Two RCTs also were exempted: one where ketamine was continuously infused in a perioperative setting [29], and another that assessed pain 6 months after ketamine injection (long-term pain prevalence) [28]. The remaining 6 studies [1,30–34] that fulfilled the inclusion criteria form the basis of this review. The key data from six RCTs included are summarized in Table 1.…”

Section: Resultsmentioning

confidence: 99%

The Effects of Low-Dose Ketamine on Acute Pain in an Emergency Setting: A Systematic Review and Meta-Analysis

Lee

2016

PLoS ONE

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ObjectivesCurrently ketamine is not used often as an analgesic in the emergency department (ED). Nonetheless, it can increase the efficiency of opioids and decrease their side effects. The purpose of this systematic review and meta-analysis was to evaluate whether low-dose ketamine in the ED provides better analgesia with fewer adverse effects.MethodsThe PubMed, EMBASE, and Cochrane Library databases were searched by two reviewers independently (last search performed on January 2016). Data were also extracted independently.ResultsA total of 6 trials involving 438 patients were included in the current analysis. Our subgroup analysis of pain reduction indicates that the favorable effects of ketamine were similar or superior to those of placebo or opioids, although these effects were heterogeneous. However, low-dose ketamine was associated with a higher risk of neurological (relative risk [RR] = 2.17, 95% confidence interval [CI] = 1.37–3.42, P < 0.001) and psychological events (RR = 13.86, 95% CI = 4.85–39.58, P < 0.001). In contrast, the opioid group had a higher risk of major cardiopulmonary events (RR = 0.22, 95% CI = 0.05–1.01, P = 0.05).ConclusionsThe efficiency of ketamine varies depending on the pain site, but low-dose ketamine may be a key agent for pain control in the ED, as it has no side effects. It may also help to reduce the side effects of opioids.

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Section: Resultsmentioning

confidence: 99%

The Effects of Low-Dose Ketamine on Acute Pain in an Emergency Setting: A Systematic Review and Meta-Analysis

Lee

2016

PLoS ONE

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“…In a study on 41 patients with limb fractures and joint dislocation carried out, Jamal et al showed that ketamine has the sedative effects similar to midazolam/fentanyl (17). Also, in another clinical trial, Motov et al showed that intravenous administration of Ketamine has shown analgesic effects similar to intravenous morphine and is useful in the short-term treatment of acute pain in emergencies (18).…”

Section: Discussionmentioning

confidence: 99%

A Comparison between the Analgesic - Sedative Effects of Ketamine and Nitrous Oxide in Bones’ Fracture Pain Control: A Randomized Clinical Trial

Motamed

Barzegari

Verki

et al. 2017

Jundishapur J Nat Pharm Prod

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Background: Analgesics such as opioids are commonly used for pain control in emergency departments. correlated respiratory side effects and central nervous system depression confine opioids application as analgesic medication. New pain control choices such as Nitric oxide and Ketamine may be alternatives. This study evaluates efficacy of Nitric Oxide versus Ketamine in purpose of pain reduction in limbs fractures. Methods: In a randomized clinical study, 75 patients that were referred to the emergency department with pain, which has been caused by bone fractures, were randomly assigned into 2 groups: receiving ketamine with an intravenous bolus dose of 0.3 mg/kg versus mixture of 50% nitrous oxide/50% Oxygen. The pain score in the groups were measured and compared by the Visual Analog Scale consecutively at arrival and 5, 10, 15 minutes after intervention. Results: Fifteen minutes after the intervention, the score of pain in patients receiving ketamine, reached 2.5 from 8.86 at the baseline. This is while in the second group, 15 minutes after the treatment, reached to 5.02 from 9.52 at the baseline. The amount of pain reduction in both groups was statistically significant. A point-by-point comparison of the amount of the pain did not show significant differences in both groups. Conclusions: The findings of this study showed that both ketamine and Nitrous Oxide/Oxygen mixture are effective in alleviating the pain of patients with limb's fracture, however, there is no precedence between these medications as a pain killer.

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“…Low-dose ketamine combined with a reduced dose hydromorphone protocol produced rapid, profound pain relief without significant side effects in a diverse cohort of ED patients with acute pain [58][59][60] . Sub-dissociative intravenous ketamine administered at 0.3 mg/kg provides analgesic effectiveness and apparent safety comparable to that of intravenous morphine in the short-term treatment of acute pain in the ED [61] . Intranasal ketamine, a convenient route of administration, reduced visual analog scale (VAS) pain scores to a clinically significant degree in 88% of ED patients in a prospective obser-www.nature.com/aps Gao M et al Acta Pharmacologica Sinica npg vational series [62] .…”

Section: Use Outside the Operating Roommentioning

confidence: 99%

Ketamine use in current clinical practice

2016

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After nearly half a century on the market, ketamine still occupies a unique corner in the medical armamentarium of anesthesiologists or clinicians treating pain. Over the last two decades, much research has been conducted highlighting the drug's mechanisms of action, specifically those of its enantiomers. Nowadays, ketamine is also being utilized for pediatric pain control in emergency department, with its anti-hyperalgesic and anti-inflammatory effects being revealed in acute and chronic pain management. Recently, new insights have been gained on ketamine's potential anti-depressive and antisuicidal effects. This article provides an overview of the drug's pharmacokinetics and pharmacodynamics while also discussing the potential benefits and risks of ketamine administration in various clinical settings.

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Intravenous Subdissociative-Dose Ketamine Versus Morphine for Analgesia in the Emergency Department: A Randomized Controlled Trial

Cited by 117 publications

References 27 publications

The Effects of Low-Dose Ketamine on Acute Pain in an Emergency Setting: A Systematic Review and Meta-Analysis

The Effects of Low-Dose Ketamine on Acute Pain in an Emergency Setting: A Systematic Review and Meta-Analysis

A Comparison between the Analgesic - Sedative Effects of Ketamine and Nitrous Oxide in Bones’ Fracture Pain Control: A Randomized Clinical Trial

Ketamine use in current clinical practice

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