The Use of Ketamine for Acute Treatment of Pain: A Randomized, Double-Blind, Placebo-Controlled Trial

Sin, Billy; Tatunchak, Tamara; Paryavi, Mohammad; Olivo, Maria; Mian, Usman; Ruiz, Josel; Shah, Bupendra; Souza, Sylvie de

doi:10.1016/j.jemermed.2016.12.039

Cited by 21 publications

(21 citation statements)

References 15 publications

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“…EMS: 1 RCT (41) found mean difference in the change of pain scores to be MD À1 (À2.2 to 0.2) at 30 min. ED: Meta-analysis of 4 RCT (42,43,45,46) found MD À0.59 (À2.24 to 1.06).…”

Section: Low (Medium Study Limitations Unknown Consistency)mentioning

confidence: 99%

Comparative Effectiveness of Analgesics to Reduce Acute Pain in the Prehospital Setting

Sobieraj

Martinez

Miao³

et al. 2019

Prehospital Emergency Care

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Objectives: The objectives of this study were to assess comparative effectiveness and harms of opioid and nonopioid analgesics for the treatment of moderate to severe acute pain in the prehospital setting. Methods: We searched MEDLINE V R , Embase V R , and Cochrane Central from the earliest date through May 9, 2019. Two investigators screened abstracts, reviewed full-text files, abstracted data, and assessed study level risk of bias. We performed meta-analyses when appropriate. Conclusions were made with consideration of established clinically important differences and we graded each conclusion's strength of evidence (SOE). Results: We included 52 randomized controlled trials and 13 observational studies. Due to the absence or insufficiency of prehospital evidence we based conclusions for initial analgesia on indirect evidence from the emergency department setting. As

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“…EMS: 1 RCT (41) found mean difference in the change of pain scores to be MD À1 (À2.2 to 0.2) at 30 min. ED: Meta-analysis of 4 RCT (42,43,45,46) found MD À0.59 (À2.24 to 1.06).…”

Section: Low (Medium Study Limitations Unknown Consistency)mentioning

confidence: 99%

Comparative Effectiveness of Analgesics to Reduce Acute Pain in the Prehospital Setting

Sobieraj

Martinez

Miao³

et al. 2019

Prehospital Emergency Care

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“…Ketamine has also been used in the emergency department for acute pain, where it showed similar analgesic effects to morphine [10]. A recent randomized, double-blind, placebo-controlled trial showed that after a subanesthetic infusion of ketamine over 15 minutes, patients reported significant decrease in pain scores for the first 30 minutes when compared to placebo infusions [11]. Another study showed increased analgesia of ketamine infusion when compared to placebo over a 2-hour period [12].…”

Section: Discussionmentioning

confidence: 99%

Ketamine Use for Successful Resolution of Post-ERCP Acute Pancreatitis Abdominal Pain

Agerwala

Sundarapandiyan

Weber

2017

Case Reports in Anesthesiology

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We report a case in which a patient with intractable pain secondary to post-endoscopic retrograde cholangiopancreatography (ERCP) acute pancreatitis is successfully treated with a subanesthetic ketamine infusion. Shortly after ERCP, the patient reported severe stabbing epigastric pain. She exhibited voluntary guarding and tenderness without distension. Amylase and lipase levels were elevated. Pain persisted for hours despite hydromorphone PCA, hydromorphone boluses, fentanyl boluses, and postprocedure anxiolytics. Pain management was consulted and a ketamine infusion was trialed, leading to a dramatic reduction in pain. This case suggests that ketamine may be a promising option in treating intractable pain associated with ERCP acute pancreatitis.

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“…Previous single-center studies have described the benefits and risks of SDDK for analgesia and dissociative sedation ketamine for severe agitation/excited delirium, but the optimal dosing range and administration method of SDDK to minimize adverse effects is unclear. [8][9][17][18] Additionally, limited, single-center studies have assessed the safety of IM ketamine for severe agitation/excited delirium in the prehospital setting and ED. [12][13][14][15][16] We designed this multicenter study to provide further insight into the safety of ketamine use in the ED for these two novel indications across a broad spectrum of EDs in a variety of settings.…”

Section: How Does This Improve Population Health?mentioning

confidence: 99%

Ketamine Safety and Use in the Emergency Department for Pain and Agitation/Delirium: A Health System Experience

Campbell

Fertel

et al. 2020

WestJEM

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Introduction: Two protocols were developed to guide the use of subdissociative dose ketamine (SDDK) for analgesia and dissociative sedation ketamine for severe agitation/excited delirium in the emergency department (ED). We sought to evaluate the safety of these protocols implemented in 18 EDs within a large health system. Methods: We conducted a retrospective chart review to evaluate all adult patients who received intravenous (IV) SDDK for analgesia and intramuscular (IM) dissociative sedation ketamine for severe agitation/excited delirium in 12 hospital-based and six freestanding EDs over a one-year period from the protocol implementation. We developed a standardized data collection form and used it to record patient information regarding ketamine use, concomitant medication use, and any comorbidities that could have impacted the incidence of adverse events. Results: Approximately 570,000 ED visits occurred during the study period. SDDK was used in 210 ED encounters, while dissociative sedation ketamine for severe agitation/excited delirium was used in 37 ED encounters. SDDK was used in 83% (15/18) of sites while dissociative sedation ketamine was used in 50% (9/18) of sites. Endotracheal intubation, non-rebreather mask, and nasal cannula ≥ four liters per minute were identified in one, five, and three patients, respectively. Neuropsychiatric adverse events were identified in 4% (9/210) of patients who received SDDK. Conclusion: Patients experienced limited neuropsychiatric adverse events from SDDK. Additionally, dissociative sedation ketamine for severe agitation/excited delirium led to less endotracheal intubation than reported in the prehospital literature. The favorable safety profile of ketamine use in the ED may prompt further increases in usage.

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The Use of Ketamine for Acute Treatment of Pain: A Randomized, Double-Blind, Placebo-Controlled Trial

Cited by 21 publications

References 15 publications

Comparative Effectiveness of Analgesics to Reduce Acute Pain in the Prehospital Setting

Comparative Effectiveness of Analgesics to Reduce Acute Pain in the Prehospital Setting

Ketamine Use for Successful Resolution of Post-ERCP Acute Pancreatitis Abdominal Pain

Ketamine Safety and Use in the Emergency Department for Pain and Agitation/Delirium: A Health System Experience

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