title: Low-dose ketamine analgesia: patient and physician experience in the ED.
abstract: OBJECTIVE
  Low-dose ketamine (LDK) may be useful for treatment for opioid-tolerant patients. We conducted a survey of patients and their treating clinicians regarding LDK for analgesia.
  
  
  METHODS
  Survey data included the following: vital signs and pain score before and after LDK, demographics, and adverse effects. Treating physicians were queried about reasons for use of LDK and overall satisfaction.
  
  
  RESULTS
  Twenty-four patients were enrolled: 21 received LDK for analgesia, and 3 received LDK for sedation. Pain level on a visual analog scale (range, 1-10) after LDK was significantly decreased from 8.9 ± 2.1 to 3.9 ± 3.4 (P < .0001). Change in vital signs after administration of LDK was not statistically significant. Overall patient satisfaction with LDK was 55%, and overall physician satisfaction was 72%. Sixteen (67%) of patients would prefer LDK again, and 23 (96%) of physicians would use LDK again for analgesia. Four patients reported an adverse experience, but there were no emergence reactions. Race subanalysis revealed no difference in pain reduction, but whites were least satisfied compared with black and Hispanic patients (P = .02). Physician reasons for using LDK included opioid failure (88%), concern for respiratory depression (17%), concern for multiple opioid allergies (13%), and concern for hypotension (8%). Most (96%) physicians believed that LDK is underused.
  
  
  CONCLUSIONS
  Low-dose ketamine may decrease patients' perception of pain. Most were satisfied with LDK for this purpose and would use it again. Whites were least satisfied with the use of LDK for analgesia. Physicians believed that ketamine is underused.
authors.affiliation: Department of Emergency Medicine, U.C. Davis Medical Center, Sacramento, CA 95817, USA. jrrichards@ucdavis.edu
authors.forename: John R
authors.initials: JR
authors.lastname: Richards
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Rockford
mesh_terms: D000328:Adult; D000700:Analgesics / Q000494:pharmacology / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D016292:Procedural Sedation; D004636:Emergency Service, Hospital; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007649:Ketamine / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010820:Physicians; D016896:Treatment Outcome; D055986:Vital Signs / Q000187:drug effects
chemical_list: D000700:Analgesics; D007649:Ketamine