Ketamine as an Analgesic Adjuvant in Adult Trauma Intensive Care Unit Patients With Rib Fracture

Walters, Mary K; Farhat, Joseph; Bischoff, James R.; Foss, Mary; Evans, Cory

doi:10.1177/1060028018768451

Cited by 30 publications

(16 citation statements)

References 21 publications

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“…The activation of the NMDA receptor sensitises to pain, while ketamine weakens this phenomenon. Decreased glutamate levels reduce the sensitivity of the cerebral cortex and limbic system to painful stimuli [7].The definitive antinociceptive effect is caused by blocking the NMDA receptor GluN2B subunit in the spinal cord [8]. Ketamine is also a muscarinic receptor antagonist in the CNS, interacting with opioid and adrenergic αand β-receptors.…”

Section: Mechanisms Of Analgesic Action Of Ketaminementioning

confidence: 99%

“…The analgesic effect of ketamine in case of intravenous administration occurs after approx. 30 seconds and lasts 5-30 minutes [7,13]. Ketamine has an analgesic effect in chronic neuropathic pain syndromes.…”

Section: Intravenous Routementioning

confidence: 99%

“…Aktywacja receptora NMDA uwrażliwia na ból, stąd ketamina osłabia to zjawisko. Obniżenie stężenia glutaminianu powoduje zmniejszenie wrażliwości kory mózgowej i układu limbicznego na bodźce bólowe [7]. Decydujący efekt antynocyceptywny powoduje blokada podjednostki GluN2B receptora NMDA w rdzeniu kręgowym [8].…”

Section: Mechanizmy Działania Przeciwbólowego Ketaminyunclassified

“…Efekt analgetyczny ketaminy po podaniu drogą dożylną występuje po około 30 sekundach i trwa 5-30 minut [7,13]. Ketamina wykazuje efekt przeciwbólowy w przewlekłych zespołach bólu neuropatycznego.…”

Section: Przegląd Badań Klinicznych Ketaminy Droga Dożylnaunclassified

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Ketamine — a unique adjuvant drug in pain treatment

Rupniewska-Ładyko

2020

Palliat Med Pract

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Section: Mechanisms Of Analgesic Action Of Ketaminementioning

confidence: 99%

Section: Intravenous Routementioning

confidence: 99%

Section: Mechanizmy Działania Przeciwbólowego Ketaminyunclassified

Section: Przegląd Badań Klinicznych Ketaminy Droga Dożylnaunclassified

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Ketamine — a unique adjuvant drug in pain treatment

Rupniewska-Ładyko

2020

Palliat Med Pract

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“…Recent studies also suggest adjuvant ketamine to be associated with greater pain relief and reduced oral opiate use in rib-fracture patients 4,5 .…”

Section: Introductionmentioning

confidence: 99%

Surgical stabilization of rib fractures is associated with improved survival but increased acute respiratory distress syndrome

Taghavi

Ali

Green

et al. 2021

Surgery

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Background How the surgical stabilization of rib fractures after trauma affects the development of acute respiratory distress syndrome and impacts survival has yet to be determined in a large database. We hypothesized that surgical stabilization of rib fractures would not decrease the incidence of acute respiratory distress syndrome. Methods The National Trauma Data Bank was queried for all traumatic rib fractures in 2016. Patients were divided into groups with single rib fractures, multiple rib fractures, and flail chest. Nonoperative therapy was compared with stabilization of rib fractures of 1 to 2 ribs or 3+ ribs. Results There were 114,972 total patients with rib fractures meeting inclusion criteria, with 5,106 (4.4%) having flail chest, 24,726 (21.5%) having single rib fractures, and 85,140 (74.1%) having multiple rib fractures. Those with flail chest (15.9%) were most likely to get rib plating in comparison to multiple rib fractures (0.9%) and single rib fractures (0.2%); P < .001. On logistic regression, surgical stabilization of rib fractures 1 to 2 ribs (odds ratio: 0.17, 95% confidence interval: 0.10–0.28) or 3+ ribs (odds ratio: 0.17, 95% confidence interval: 0.11–0.28), with nonoperative therapy as the reference was associated with survival. Variables associated with mortality included increasing age, male sex, increasing injury severity score, decreased Glasgow coma scale, requirement of transfusions, and hypotension on admission. Surgical stabilization of rib fractures 3+ ribs (odds ratio: 2.30, 95% confidence interval: 1.58–3.37) was associated with acute respiratory distress syndrome but not 1 to 2 ribs (odd ratio: 1.55, 95% confidence interval: 0.97–2.48). On logistic regression of only patients with flail chest, stabilization of rib fractures was associated with decreased mortality but not increased risk of acute respiratory distress syndrome. Conclusion The increased risk of acute respiratory distress syndrome should be considered in the preoperative assessment for stabilization of rib fractures.

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Pain Management Considerations in Patients With Opioid Use Disorder Requiring Critical Care

Smith

Wang

Abdukalikov

et al. 2022

The Journal of Clinical Pharma

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The opioid epidemic has resulted in increased opioid‐related critical care admissions, presenting challenges in acute pain management. Limited guidance exists in the management of critically ill patients with opioid use disorder (OUD). This narrative review provides the intensive care unit clinician with guidance and treatment options, including nonopioid analgesia, for patients receiving medications for OUD and for patients actively misusing opioids. Verification and continuation of the patient's outpatient medications for OUD regimen, specifically buprenorphine and methadone formulations; assessment of pain and opioid withdrawal; and treatment of acute pain with nonopioid analgesia, nonpharmacologic strategies, and short‐acting opioids as needed, are all essential to adequate management of acute pain in patients with OUD. A multidisciplinary approach to treatment and discharge planning in patients with OUD may be beneficial to engage patients with OUD early in their hospital stay to prevent withdrawal, stabilize their OUD, and reduce the risk of unplanned discharge and other associated morbidity.

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Ketamine as an Analgesic Adjuvant in Adult Trauma Intensive Care Unit Patients With Rib Fracture

Abstract: Low-dose ketamine appears to be a safe and effective adjuvant option to reduce pain and decrease opioid use in rib fracture.

Cited by 30 publications

References 21 publications

Ketamine — a unique adjuvant drug in pain treatment

Ketamine — a unique adjuvant drug in pain treatment

Surgical stabilization of rib fractures is associated with improved survival but increased acute respiratory distress syndrome

Pain Management Considerations in Patients With Opioid Use Disorder Requiring Critical Care

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