Ketamine Use in Operation Enduring Freedom

Abstract

Introduction Ketamine is a dissociative anesthetic increasingly used in the prehospital and battlefield environment. As an analgesic, it has been shown to have comparable effects to opioids. In 2012, the Defense Health Board advised the Joint Trauma System to update the Tactical Combat Casualty Care Guidelines to include ketamine as an acceptable first line agent for pain control on the battlefield. The goal of this study was to investigate trends in the use of ketamine during Operation Enduring Freedom (OEF) and Operation Freedom’s Sentinel (OFS) during the years 2011-2016. Materials and Methods A retrospective review of Department of Defense Trauma Registry (DoDTR) data was performed for all patients receiving ketamine during OEF/OFS in 2011-2016. Prevalence of ketamine use, absolute use, mechanism of injury, demographics, injury severity score, provider type, and co-administration rates of various medications and blood products were evaluated. Results Total number of administrations during the study period was 866. Ketamine administration during OEF/OFS increased during the years 2011-2013 (28 patient administrations in 2011, 264 administrations in 2012, and 389 administrations in 2013). A decline in absolute use was noted from 2014 to 2016 (98 administrations in 2014, 41 administrations in 2015, and 46 administrations in 2016). The frequency of battlefield ketamine use increased from 0.4% to 11.3% for combat injuries sustained in OEF/OFS from 2011 to 2016. Explosives (51%) and penetrating trauma (39%) were the most common pattern of injury in which ketamine was administered. Ketamine was co-administered with fentanyl (34.4%), morphine (26.2%), midazolam (23.1%), tranexamic acid (12.3%), plasma (10.3%), and packed red blood cells (18.5%). Conclusions This study demonstrates increasing use of ketamine by the U.S. Military on the battlefield and effectiveness of clinical practice guidelines in influencing practice patterns.

Ketamine decreased opiate use in US military combat operations from 2010 to 2019

“…Ketamine use in the US military was established in a 2012 Tactical Combat Casualty Care (TCCC) memorandum and formalised in the 2014 TCCC update. Prior studies have demonstrated increased ketamine usage rates by military medical personnel following updates of TCCC guidelines but only one previous small study has sought to evaluate the subsequent effect on opioid use 18 19. This study aimed to assess the effect of ketamine adoption on opioid usage in all US combat operations over a 10-year period and to demonstrate an opioid-sparing effect of ketamine protocols.…”

Effects of a Subanesthetic Ketamine Infusion on Inflammatory and Behavioral Outcomes after Closed Head Injury in Rats

“…Ketamine, a multimodal dissociative anesthetic, is a common analgesic administered to combat-wounded service members in a forward-deployed setting [ 23 , 24 , 25 ]. It is used as a trauma analgesic and anesthetic alone or in conjunction with opioids [ 26 ] because it preserves respiration and hemodynamic stability after injury [ 23 , 27 ].…”