Narrative Review: Low-Dose Ketamine for Pain Management

Riccardi, Alessandro; Guarino, Mario; Serra, Sossio; Spampinato, Michele Domenico; Vanni, Simone; Shiffer, Dana; Voza, Antonio; Fabbri, Andrea; Iaco, Fabio De

doi:10.3390/jcm12093256

Cited by 16 publications

(5 citation statements)

References 287 publications

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“…A study comparing an intravenous subdissociative dose of ketamine with morphine for analgesia in geriatric patients showed comparable analgesia with higher rates of psychoperceptual side effects [ 28 ]. A slower metabolism in elderly patients was discussed [ 29 ]. A study of low-dose esketamine for induction of anesthesia in elderly patients undergoing knee arthroplasty again showed no adverse events in the recovery period [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Patient-reported side effects and satisfaction of pre-hospital analgesia with low-dose esketamine: a cross-sectional study

Häske,

Eppler,

Heinemann

et al. 2023

BMC Emerg Med

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Background Analgesia is a core intervention in emergency medicine. Pain is subjective, so patient-reported experience with pain and analgesia is essential for healthcare professionals. The aim of this study was to evaluate patient-reported side effects and satisfaction associated with pre-hospital analgesia with low-dose esketamine. Methods This is an observational cross-sectional study conducted as part of quality assurance measures of the German Red Cross Emergency Medical Service, Reutlingen, Germany. The survey was administered to all patients who received prehospital esketamine analgesia from paramedics. Addresses were obtained from medical records and mailed 10 days after the event. Patient feedback was anonymous and could not be linked to operational documentation. Results A total of 201 patients were contacted, and 119 responses were received via the online questionnaire and postal mail (response rate 59%). The mean age of the patients was 68±13 years, with 64.7% (n=77) being female. The main diagnosis reported was fractures of the extremities in 69.7%. Patients reported initial median pain intensity on a Numeric Rating Scale (NRS) of 10 [8-10]. Pain was unbearable for 96.3% of patients. After administration of analgesia, 95.3% were satisfied or very satisfied. Patients reported no side effects in 78.5%, minor side effects in 10.0%, significant but well tolerable side effects in 11.3%, borderline tolerable side effects in 0.2%, and no unbearable side effects. Borderline tolerable nausea was reported in 2% of patients along with dreams in 0.8%. No nightmares were reported. Further analysis showed that patients older than 80 years reported significantly more side effects (p < 0.001) and were thus less satisfied with the analgesia. Conclusions Both patient perception and analgesia with few side effects were important for both safety and satisfaction. In the present study, low-dose esketamine analgesia was associated with low side effects and high patient satisfaction.

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Section: Discussionmentioning

confidence: 99%

Patient-reported side effects and satisfaction of pre-hospital analgesia with low-dose esketamine: a cross-sectional study

Häske,

Eppler,

Heinemann

et al. 2023

BMC Emerg Med

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“…Ketamine inhibits glutamatergic neurons primarily through its antagonistic action on NMDA receptors. However, its action on dopaminergic, adrenergic, serotoninergic, opioid, and cholinergic receptors, as well as on spinal GABA interneurons, appears to be responsible for the analgesic effect of this drug, which is effective in chronic, neuropathic and cancer pain [ 99 ]. In addition, corticosteroids, and magnesium sulphate [ 100 , 101 , 102 ] have been shown to be useful adjuvants, especially in neuropathic pain and bone pain [ 103 , 104 , 105 ].…”

Section: Discussionmentioning

confidence: 99%

“…The initial treatment consists of reducing or eliminating the current opioid dose or switching to an opioid with less neurotoxic effects, such as fentanyl, and maximising non-opioid adjuvants when indicated. The use of low-dose ketamine for pain relief may have a role in the management of this issue in the ED [ 99 ].…”

Section: Discussionmentioning

confidence: 99%

Pain Management at the End of Life in the Emergency Department: A Narrative Review of the Literature and a Practical Clinical Approach

Serra

Spampinato

Riccardi³

et al. 2023

JCM

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Access to pain management is a fundamental human right for all people, including those who are at the end of life (EOL). In end-stage patients, severe and uncontrolled pain is a common cause of admission to the emergency department (ED), and its treatment is challenging due to its complex, often multifactorial genesis. The aim of this narrative review was to identify the available literature on the management of severe EOL pain in the ED. The MEDLINE, SCOPUS, EMBASE, and CENTRAL databases were searched from inception to 1 April 2023 including randomised controlled trials, observational studies, systemic or narrative reviews, case reports, and guidelines on the management of EOL pain in the ED. A total of 532 articles were identified, and 9 articles were included (5 narrative reviews, 2 retrospective studies, and 2 prospective studies). Included studies were heterogeneous on the scales used and recommended for pain assessment and the recommended treatments. No study provided evidence for a better approach for EOL patients with pain in the ED. We provide a narrative summary of the findings and a review of the management of EOL pain in clinical practice, including (i) the identification of the EOL patients and unmet palliative care needs, (ii) a multidimensional, patient-centred assessment of the type and severity of pain, (iii) a multidisciplinary approach to the management of end-of-life pain, including an overview of non-pharmacological and pharmacological techniques; and (iv) the management of special situations, including rapid acute deterioration of chronic pain, breakthrough pain, and sedative palliation.

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“…Ketamine administered at three different doses (0.15 mg/kg, 0.30 mg/kg, and 0.45 mg/kg) during the performance of the procedures has been shown to decrease patient response, facilitate lumbar puncture, and improve hemodynamic parameters [6]. The side effects of ketamine include hypertension, nausea, agitation, confusion, and hallucinations, although these are dose-dependent and are extremely rare at low doses [8][9][10]. It was observed that the undesirable side effects of ketamine increased at doses of 0.45 mg/kg and above [6].…”

Section: Introductionmentioning

confidence: 99%

The Effect of Preprocedural Low-Dose Ketamine for Pain and Anxiety in Patients during Thoracic Epidural Catheterization

Küçük,

Sarı,

Zengin

et al. 2024

Medicina

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Background and Objectives: Thoracic epidural catheterization (TEC) can be both uncomfortable and fearful for patients when performed awake with the thought that the procedure may be painful. The aim of this study was to assess the effect of low-dose intravenous ketamine administration on pain and anxiety during the TEC procedure. Materials and Methods: Sixty patients were randomly divided into two groups to receive intravenous (IV) placebo (Group P) and IV low-dose (0.15 mg/kg) ketamine (LDK) (Group K) 3 min before the procedure in a double-blind manner. A visual analog scale (VAS) was used to measure anxiety (VAS-A) and pain (VAS-P) scores. Vital parameters were monitored before premedication (T1), 20 min after premedication (T2), during skin anesthesia (T3), during TEC (T4), and 5 min after TEC (T5). VAS-A values were recorded at T1, T3, T4, and T5 periods, and VAS-P levels were noted at T3, T4, and T5 periods. Results: During TEC (T4), both VAS-P and VAS-A were significantly lower in Group K (p < 0.001). The mean VAS-A value was 10.6 mm lower, and the mean VAS-P value was 9 mm lower in Group K than in Group P at the T4 time point. Additionally, the mean VAS-P value was 7.7 mm lower in Group K compared to Group P at the T3 time point (p < 0.001). Both groups showed a statistically significant difference in VAS-A measurements when compared at their respective time points (p < 0.001). However, only Group P demonstrated a statistically significant difference in VAS-P measurements (p < 0.001). VAS-P values remained stable in Group K. The number of patients who did not recall the procedure was significantly higher in Group K (p < 0.001). Furthermore, the number of patients who would consent to the same procedure in the future was significantly higher in Group K (p = 0.007). Conclusions: A preprocedural LDK (0.15 mg/kg) can effectively prevent anxiety and pain experienced by patients during the TEC procedure. Administration of LDK may provide a more comfortable procedure process without causing ketamine-induced side effects (hemodynamic, respiratory, and psychological).

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Narrative Review: Low-Dose Ketamine for Pain Management

Cited by 16 publications

References 287 publications

Patient-reported side effects and satisfaction of pre-hospital analgesia with low-dose esketamine: a cross-sectional study

Patient-reported side effects and satisfaction of pre-hospital analgesia with low-dose esketamine: a cross-sectional study

Pain Management at the End of Life in the Emergency Department: A Narrative Review of the Literature and a Practical Clinical Approach

The Effect of Preprocedural Low-Dose Ketamine for Pain and Anxiety in Patients during Thoracic Epidural Catheterization

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