Low-dose ketamine for analgesia in the ED: a retrospective case series

Lester, Laeben; Braude, Darren; Nilès, Christopher; Crandall, Cameron

doi:10.1016/j.ajem.2009.07.023

Cited by 45 publications

(30 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a case series by Lester et al, 25 satisfactory pain control was reported in 19 of 35 (54%) patients who received ketamine as an IV or intramuscular injection. Ketamine was dosed between 0.1 and 0.6 mg/kg/dose.…”

Section: Discussionmentioning

confidence: 99%

The Use of Subdissociative‐dose Ketamine for Acute Pain in the Emergency Department

Sin

Ternas

Motov

2015

Academic Emergency Medicine

View full text Add to dashboard Cite

Objectives: Ketamine is a well-known anesthetic with its use trailing back to the 1960s. It has antagonistic effects at the N-methyl-D-aspartate receptor. There is emerging literature to suggest the use of subdissociative-dose ketamine (SDDK) for pain reduction. This evidence-based review evaluates the evidence regarding the use of SDDK for acute pain control in the emergency department (ED). Methods:The MEDLINE and EMBASE databases were searched. Randomized controlled trials (RCTs) that described or evaluated the use of SDDK for acute pain in the ED were included. Literature was excluded if it was not published in English. Duplicate articles, unpublished reports, abstracts, and review articles were also excluded. Quality assessment and evaluation of literature were evaluated based on the GRADE criteria. The primary outcome of interest in this review was the difference in pain score from baseline to cutoff time as specified in the studies. Secondary outcome measures were the incidence of adverse events and reduction in the amount of adjuvant opioids consumed by patients who received SDDK.Results: Four RCTs met the inclusion criteria, which enrolled a total of 428 patients. Three adult trials and one pediatric trial were identified. The level of evidence for the individual trials ranged from low to moderate. A significant reduction in pain scores was only found in two of the four trials. One trial found a significant reduction in mean pain scores when ketamine was compared to morphine (p < 0.05). Another trial reported a significant decrease in mean distress scores, favoring SDDK over fentanyl (1.0 vs. 2.7, p < 0.05). One trial found a significant reduction in the amount of morphine consumed, favoring ketamine over placebo (0.14 mg/kg, 95% confidence interval [CI] = 0.13 to 0.16 mg/kg vs. 0.2 mg/kg, 95% CI = 0.18 to 0.22 mg/kg; p < 0.001). An emergence phenomenon was reported in one trial.Conclusions: Four RCTs with methodologic limitations failed to provide convincing evidence to either support or refute the use of SDDK for acute pain control in the ED.ACADEMIC EMERGENCY MEDICINE 2015;22:251-257

show abstract

Section: Discussionmentioning

confidence: 99%

The Use of Subdissociative‐dose Ketamine for Acute Pain in the Emergency Department

Sin

Ternas

Motov

2015

Academic Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…Several small observational or open-label studies have demonstrated either morphine-sparing effects or reductions in pain severity when low-dose ketamine is employed for pain in the prehospital or ED setting. [8][9][10][11][12] However, lack of randomized controlled clinical trials examining the effectiveness of low-dose ketamine in the ED may partly explain why it has not been incorporated into regular clinical practice. In addition, guidance is needed regarding the optimum dose for ketamine as an adjunct analgesic; studied doses have ranged from 0.05 to 1 mg/kg, and various methods and routes of administration have been employed (single bolus, repeat dosing, or continuous infusion; IV, intramuscular, intranasal, or intrathecal).…”

mentioning

confidence: 99%

Low‐dose Ketamine Improves Pain Relief in Patients Receiving Intravenous Opioids for Acute Pain in the Emergency Department: Results of a Randomized, Double‐blind, Clinical Trial

Beaudoin

Lin

Guan

et al. 2014

Academic Emergency Medicine

112

View full text Add to dashboard Cite

ObjectivesLow‐dose ketamine has been used perioperatively for pain control and may be a useful adjunct to intravenous (IV) opioids in the control of acute pain in the emergency department (ED). The aim of this study was to determine the effectiveness of low‐dose ketamine as an adjunct to morphine versus standard care with morphine alone for the treatment of acute moderate to severe pain among ED patients.MethodsA double‐blind, randomized, placebo‐controlled trial with three study groups was conducted at a large, urban academic ED over a 10‐month period. Eligible patients were 18 to 65 years old with acute moderate to severe pain (score of at least 5 out of 10 on the numerical pain rating scale [NRS] and pain duration < 7 days) who were deemed by their treating physician to require IV opioids. The three study groups were: 1) morphine and normal saline placebo (standard care group), 2) morphine and 0.15 mg/kg ketamine (group 1), or 3) morphine and 0.3 mg/kg ketamine (group 2). Participants were assessed at 30, 60, and 120 minutes after study medication administration and received rescue analgesia as needed to target a 50% reduction in pain. The primary outcome measure of pain relief, or pain intensity reduction, was derived using the NRS and calculated as the summed pain‐intensity (SPID) difference over 2 hours. The amount and timing of rescue opioid analgesia was evaluated as a secondary outcome. The occurrence of adverse events was also measured.ResultsSixty patients were enrolled (n = 20 in each group). There were no differences between study groups with respect to age, sex, race/ethnicity, preenrollment analgesia, or baseline NRS. Over the 2‐hour poststudy medication administration period, the SPIDs were higher (greater pain relief) for the ketamine study groups than the control group (standard care 4.0, interquartile range [IQR] = 1.8 to 6.5; group 1 7.0, IQR = 4.3 to 10.8; and group 2 7.8, IQR = 4.8 to 12.8; p < 0.02). The SPIDs for the ketamine groups were similar (p < 0.46). When compared to standard care, group 2 sustained the reduction in pain intensity up to 2 hours, whereas group 1 was similar to standard care by 2 hours. Similar numbers of patients received rescue analgesia: standard care group, seven of 20, 35%; group 1, four of 20, 20%; and group 2, four of 20, 20% (p = 0.48). Among those receiving rescue analgesia, those in the standard care group received analgesia sooner than either low‐dose ketamine group, on average. More participants in the low‐dose ketamine groups reported dysphoria and dizziness.ConclusionsLow‐dose ketamine is a viable analgesic adjunct to morphine for the treatment of moderate to severe acute pain. Dosing of 0.3 mg/kg is possibly more effective than 0.15 mg/kg, but may be associated with minor adverse events. Future studies should evaluate additional outcomes, optimum dosing, and use in specific populations.

show abstract

“…Most of the studies evaluating ketamine as an analgesic in the emergency setting used it as adjunctive therapy in addition to an opioid [7,16,17,[20][21][22][23][24][25][26]. A few observational studies and one randomized controlled trial (RCT) evaluated the use of low-dose ketamine alone [19,[27][28][29].…”

Section: To the Editormentioning

confidence: 98%

“…In a large retrospective study evaluating low-dose ketamine (0.1 to 0.3 mg/kg, intravenously or intramuscularly) administered in the ED for analgesia (n = 530), only 6% of patients developed a mild adverse event, which rarely altered the patient's clinical course [30]. Low-dose ketamine use for analgesia in the emergency setting has generally been shown to be well tolerated [7,17,19,21,22,[24][25][26][27][28][29][30][31]. The differences in adverse effects associated with ketamine administration may be due to interstudy variability in the study populations, the dosing strategies used, or random error due to the small study populations.…”

Section: To the Editormentioning

confidence: 98%

Evaluation of analgesic effects of ketamine through sub-dissociative dosing in the ED

Riha¹,

Aaronson²,

Schmidt³

2015

The American Journal of Emergency Medicine

View full text Add to dashboard Cite

Low-dose ketamine for analgesia in the ED: a retrospective case series

Cited by 45 publications

References 35 publications

The Use of Subdissociative‐dose Ketamine for Acute Pain in the Emergency Department

The Use of Subdissociative‐dose Ketamine for Acute Pain in the Emergency Department

Low‐dose Ketamine Improves Pain Relief in Patients Receiving Intravenous Opioids for Acute Pain in the Emergency Department: Results of a Randomized, Double‐blind, Clinical Trial

Evaluation of analgesic effects of ketamine through sub-dissociative dosing in the ED

Contact Info

Product

Resources

About