Ketamine as an Adjunct to Opioids for Acute Pain in the Emergency Department: A Randomized Controlled Trial

Bowers, Karen J.; McAllister, Kelly; Ray, Meredith; Heitz, Corey

doi:10.1111/acem.13172

Cited by 37 publications

(37 citation statements)

References 21 publications

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“…Recently, administrations of low, sub-anesthetic doses of ketamine either alone or as an adjunct to opioid therapies have been shown to be an effective treatment in postoperative and acute pain settings [ 8 – 12 ]. In addition, ketamine has long been safely used as an general anesthetic and analgesic agent [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Ketamine normalizes high-gamma power in the anterior cingulate cortex in a rat chronic pain model

et al. 2020

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Chronic pain alters cortical and subcortical plasticity, causing enhanced sensory and affective responses to peripheral nociceptive inputs. Previous studies have shown that ketamine had the potential to inhibit abnormally amplified affective responses of single neurons by suppressing hyperactivity in the anterior cingulate cortex (ACC). However, the mechanism of this enduring effect has yet to be understood at the network level. In this study, we recorded local field potentials from the ACC of freely moving rats. Animals were injected with complete Freund’s adjuvant (CFA) to induce persistent inflammatory pain. Mechanical stimulations were administered to the hind paw before and after CFA administration. We found a significant increase in the high-gamma band (60–100 Hz) power in response to evoked pain after CFA treatment. Ketamine, however, reduced the high-gamma band power in response to evoked pain in CFA-treated rats. In addition, ketamine had a sustained effect on the high-gamma band power lasting up to five days after a single dose administration. These results demonstrate that ketamine has the potential to alter maladaptive neural responses in the ACC induced by chronic pain.

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Section: Introductionmentioning

confidence: 99%

Ketamine normalizes high-gamma power in the anterior cingulate cortex in a rat chronic pain model

et al. 2020

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“…Low-dose boluses of ketamine (0.1-0.3 mg/kg) have been shown to reduce pain scores and opiate consumption when used as an adjunct to opiate therapy in acute pain treatment. 9,14,15 Clinical benefits can last up to 2 hours Continuous infusions can reduce consumption of opiates and concomitant sedatives.…”

Section: Bolus Dosingmentioning

confidence: 99%

“…after a single administration. 15 Compared with lower doses, a dose of 0.3 mg/kg has been found to be more effective in reducing pain scores. 9 However, higher doses are associated with more frequent minor adverse events.…”

Section: Bolus Dosingmentioning

confidence: 99%

Ketamine for Acute Pain Management and Sedation

Brown

Tucker

2020

Critical Care Nurse

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Topic Ketamine is beneficial in clinical settings ranging from procedural sedation to the treatment of chronic pain. This article describes the clinical benefits of ketamine for treatment of acute pain and for sedation of patients undergoing mechanical ventilation. Clinical Relevance Ketamine causes analgesic and amnestic effects by noncompetitive inhibition of the N-methyl-D-aspartate receptor and activation of the opioid μ and κ receptors. Unlike other sedatives, ketamine provides analgesia and amnesia without causing hypotension or respiratory depression. Several studies have elucidated the clinical benefits of ketamine. The use of ketamine has extended beyond critical care areas such as the operating room and intensive care units. Nurses must be familiar with optimal clinical scenarios, monitoring parameters, and contraindications of ketamine. Purpose To highlight the clinical utility and pharmacological properties of ketamine through a literature review. Current studies of ketamine in acute pain and sedation management are summarized. Content Covered This narrative review describes pharmacological properties, dosing strategies, administration considerations, and adverse effects of ketamine.

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“…A double-blind randomized placebo trial found that ketamine, as an adjunct, was effective in acute pain control and lowered the overall opioid dose utilized by the patients in the ketamine group [29]. Although further studies are needed to further evaluate the efficacy of ketamine versus other opioid analgesics with higher confidence, it is important to recognize the lower demand and lower dose administration of opioid analgesics while using ketamine for acute pain control [29].…”

Section: Comparison In the Reduction Of Acute Painmentioning

confidence: 99%

Low Dose Ketamine Used for Acute Pain Management in the Emergency Department

Kestenian¹,

Gantioque²,

Snyder³

2020

OJEM

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The use of opioid analgesics has created an opioid addiction epidemic in the United States and around the world. One of the main responsibilities of the emergency department is to address acute pain. In this paper we examine the use of low dose ketamine as a safe substitute for opioid analgesics. Types of pain are identified using prior established taxonomy, followed by discussing types of management and treatments. The opioid epidemic and its societal implications are considered. We also examine the side effects of ketamine and the use of ketamine as an adjunct to analgesics used for pain control. Recommendations and considerations for the use of ketamine are suggested, and a low dose ketamine administration sample hospital policy is reviewed.

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Ketamine as an Adjunct to Opioids for Acute Pain in the Emergency Department: A Randomized Controlled Trial

Cited by 37 publications

References 21 publications

Ketamine normalizes high-gamma power in the anterior cingulate cortex in a rat chronic pain model

Ketamine normalizes high-gamma power in the anterior cingulate cortex in a rat chronic pain model

Ketamine for Acute Pain Management and Sedation

Low Dose Ketamine Used for Acute Pain Management in the Emergency Department

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