title: Sub-dissociative dose intranasal ketamine for limb injury pain in children in the emergency department: a pilot study.
abstract: OBJECTIVE
  The present study aims to conduct a pilot study examining the effectiveness of intranasal (IN) ketamine as an analgesic for children in the ED.
  
  
  METHODS
  The present study used an observational study on a convenience sample of paediatric ED patients aged 3-13 years, with moderate to severe (≥6/10) pain from isolated limb injury. IN ketamine was administered at enrolment, with a supplementary dose after 15 min, if required. Primary outcome was change in median pain rating at 30 min. Secondary outcomes included change in median pain rating at 60 min, patient/parent satisfaction, need for additional analgesia and adverse events being reported.
  
  
  RESULTS
  For the 28 children included in the primary analysis, median age was 9 years (interquartile range [IQR] 6-10). Twenty-three (82.1%) were male. Eighteen (64%) received only one dose of IN ketamine (mean dose 0.84 mg/kg), whereas 10 (36%) required a second dose at 15 min (mean for second dose 0.54 mg/kg). The total mean dose for all patients was 1.0 mg/kg (95% CI: 0.92-1.14). The median pain rating decreased from 74.5 mm (IQR 60-85) to 30 mm (IQR 12-51.5) at 30 min (P < 0.001, Mann-Whitney). For the 24 children who contributed data at 60 min, the median pain rating was 25 mm (IQR 4-44). Twenty (83%) subjects were satisfied with their analgesia. Eight (33%) were given additional opioid analgesia and the 28 reported adverse events were all transient and mild.
  
  
  CONCLUSIONS
  In this population, an average dose of 1.0 mg/kg IN ketamine provided adequate analgesia by 30 min for most patients.
authors.affiliation: Southern Health Emergency Medicine Research Group, Southern Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Yeaman
authors.forename: Ed
authors.initials: E
authors.lastname: Oakley
authors.forename: Robert
authors.initials: R
authors.lastname: Meek
authors.forename: Andis
authors.initials: A
authors.lastname: Graudins
mesh_terms: D000281:Administration, Intranasal; D000293:Adolescent; D000700:Analgesics / Q000008:administration & dosage* / Q000627:therapeutic use; D001315:Australia; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005121:Extremities / Q000293:injuries*; D005260:Female; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D009520:New Zealand; D010146:Pain / Q000188:drug therapy* / Q000523:psychology; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010865:Pilot Projects; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D007649:Ketamine