title: Low-Dose Ketamine Infusion for Emergency Department Patients with Severe Pain.
abstract: OBJECTIVE
  Use of low-dose ketamine infusions in the emergency department (ED) has not previously been described, despite routine use in perioperative and other settings. Our hypothesis was that a low-dose ketamine bolus followed by continuous infusion would 1) provide clinically significant and sustained pain relief; 2) be well tolerated; and 3) be feasible in the ED.
  
  
  METHODS
  We prospectively administered 15 mg intravenous ketamine followed immediately by continuous ketamine infusion at 20 mg/h for 1 hour. Optional morphine (4 mg) was offered at 20, 40, and 60 minutes. Pain intensity, vitals signs, level of sedation, and adverse reactions were assessed for 120 minutes.
  
  
  RESULTS
  A total of 38 patients were included with a median initial numerical rating scale (NRS) pain score of 9. At 10 minutes, the median reduction in pain score was 4, with 7 patients reporting a score of 0. At 60 and 120 minutes, 25 and 26 patients, respectively, reported clinically significant pain reduction (decrease NRS score > 3). Heart rate, blood pressure, respiratory rate, and oxygen saturation remained stable. Mild or moderate side effects including dizziness, fatigue, and headache were common. Patient satisfaction was high; 85% reported they would have this medication again for similar pain.
  
  
  CONCLUSIONS
  A low-dose ketamine infusion protocol provided significant pain relief with mostly mild side effects and no severe adverse events.
authors: Departments of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland.
authors: Terence L
authors: TL
authors: Ahern
authors: Departments of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland.|Emergency Medicine, University of California, San Francisco, California, USA.
authors: Andrew A
authors: AA
authors: Herring
authors: Departments of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland.
authors: Steve
authors: S
authors: Miller
authors: Departments of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland.|Emergency Medicine, University of California, San Francisco, California, USA.
authors: Bradley W
authors: BW
authors: Frazee
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects; D004244:Dizziness / Q000139:chemically induced; D004305:Dose-Response Relationship, Drug; D004636:Emergency Service, Hospital; D005221:Fatigue / Q000139:chemically induced; D005260:Female; D006261:Headache / Q000139:chemically induced; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous / Q000379:methods; D007649:Ketamine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D010100:Oxygen / Q000378:metabolism; D010146:Pain / Q000188:drug therapy*; D059408:Pain Management / Q000009:adverse effects / Q000379:methods* / Q000523:psychology; D010147:Pain Measurement / Q000379:methods; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011446:Prospective Studies; D056152:Respiratory Rate / Q000187:drug effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D007649:Ketamine; D009020:Morphine; D010100:Oxygen
keywords: Acute Pain; Analgesia; Emergency Service; Intravenous Infusions; Ketamine