Is There a Role for Intravenous Subdissociative-Dose Ketamine Administered as an Adjunct to Opioids or as a Single Agent for Acute Pain Management in the Emergency Department?
BACKGROUND
Whether acute or chronic, emergency physicians frequently encounter patients reporting pain. It is the responsibility of the emergency physician to assess and evaluate, and if appropriate, safely and effectively reduce pain. Recently, analgesics other than opioids are being considered in an effort to provide safe alternatives for pain management in the emergency department (ED). Opioids have significant adverse effects such as respiratory depression, hypotension, and sedation, to say nothing of their potential for abuse. Although ketamine has long been used in the ED for procedural sedation and rapid sequence intubation, it is used infrequently for analgesia. Recent evidence suggests that ketamine use in subdissociative doses proves to be effective for pain control and serves as a feasible alternative to traditional opioids. This paper evaluates ketamine's analgesic effectiveness and safety in the ED.


METHODS
This is a literature review of randomized controlled trials, systematic reviews, meta-analyses, and observational studies evaluating ketamine for pain control in the ED setting. Based on these search parameters, eight studies were included in the final analysis and graded based on the American Academy of Emergency Medicine Clinical Practice Committee manuscript review process.


RESULTS
A total of eight papers were reviewed in detail and graded. Recommendations were given based upon this review process.


CONCLUSIONS
Subdissociative-dose ketamine (low-dose ketamine) is effective and safe to use alone or in combination with opioid analgesics for the treatment of acute pain in the ED. Its use is associated with higher rates of minor, but well-tolerated adverse side effects.
Maimonides Medical Center, Brooklyn, New York.
Sergey
S
Motov
American Academy of Emergency Medicine, Milwaukee, Wisconsin.
Steven
S
Rosenbaum
University of California at San Diego Medical Center, San Diego, California.
Gary M
GM
Vilke
University of California at San Diego Medical Center, San Diego, California.
Yuko
Y
Nakajima
D059787:Acute Pain / Q000188:drug therapy*; D061605:Administration, Intravenous; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000778:Anesthetics, Dissociative / Q000008:administration & dosage* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage* / Q000627:therapeutic use; D059408:Pain Management / Q000379:methods; D016032:Randomized Controlled Trials as Topic
D000701:Analgesics, Opioid; D000778:Anesthetics, Dissociative; D007649:Ketamine
analgesia; low-dose ketamine; subdissociative-dose ketamine