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Am J Emerg Med. 2017 Aug;35(8):1095-1100. doi: 10.1016/j.ajem.2017.03.004. Epub 2017 Mar 3.

A prospective randomized, double-dummy trial comparing IV push low dose ketamine to short infusion of low dose ketamine for treatment of  pain in the ED.

Author information

1
Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA. Electronic address: smotov@maimonidesmed.org.
2
Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA.
3
Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY, USA.
4
Office of Research Administration, Maimonides Medical Center, Brooklyn, NY, USA; Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.

Abstract

STUDY OBJECTIVE:

Compare adverse effects and analgesic efficacy of low-dose ketamine for acute pain in the ED administered either by single intravenous push (IVP) or short infusion (SI).

METHODS:

Patients 18-65, presenting to ED with acute abdominal, flank, or musculoskeletal pain with initial pain score≥5, were randomized to ketamine 0.3mg/kg by either IVP or SI with placebo double-dummy. Adverse effects were evaluated by Side Effects Rating Scale for Dissociative Anesthetics (SERSDA) and Richmond Agitation-Sedation Scale (RASS) at 5, 15, 30, 60, 90, and 120min post-administration; analgesic efficacy was evaluated by Numerical Rating Scale (NRS).

RESULTS:

48 patients enrolled in the study. IVP group had higher overall rates of feeling of unreality on SERSDA scale: 92% versus 54% (difference 37.5%; p=0.008; 95% CI 9.3-59.5%). At 5min median severity of feeling of unreality was 3.0 for IVP versus 0.0 for SI (p=0.001). IVP also showed greater rates of sedation on RASS scale at 5min: median RASS -2.0 versus 0.0 (p=0.01). Decrease in mean pain scores from baseline to 15min was similar across groups: 5.2±3.53 (95% CI 3.7-6.7) for IVP; 5.75±3.48 (95% CI 4.3-7.2) for SI. There were no statistically significant differences with respect to changes in vital signs and need for rescue medication.

CONCLUSION:

Low-dose ketamine given as a short infusion is associated with significantly lower rates of feeling of unreality and sedation with no difference in analgesic efficacy in comparison to intravenous push.

KEYWORDS:

Analgesia; Emergency department; Infusion; Ketamine

PMID:
28283340
DOI:
10.1016/j.ajem.2017.03.004
[Indexed for MEDLINE]

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