Intranasal ketamine for acute traumatic pain in the Emergency Department: a prospective, randomized clinical trial of efficacy and safety.
Ketamine has been well studied for its efficacy as an analgesic agent. However, intranasal (IN) administration of ketamine has only recently been studied in the emergency setting. The objective of this study was to elucidate the efficacy and adverse effects of a sub-dissociative dose of IN Ketamine compared to IV and IM morphine.



A single-center, randomized, prospective, parallel clinical trial of efficacy and safety of IN ketamine compared to IV and IM morphine for analgesia in the emergency department (ED). A convenience sample of 90 patients aged 18-70 experiencing moderate-severe acute traumatic pain (≥80 mm on 100 mm Visual Analog Scale [VAS]) were randomized to receive either 1.0 mg/kg IN ketamine, 0.1 mg/kg IV MO or 0.15 mg/kg IM MO. Pain relief and adverse effects were recorded for 1 h post-administration. The primary outcome was efficacy of IN ketamine compared to IV and IM MO, measured by "time-to-onset" (defined as a ≥15 mm pain decrease on VAS), as well as time to and degree of maximal pain reduction.



The 3 study groups showed a highly significant, similar maximal pain reduction of 56 ± 26 mm for IN Ketamine, and 59 ± 22 and 48 ± 30 for IV MO and IM MO, respectively. IN Ketamine provided clinically-comparable results to those of IV MO with regards to time to onset (14.3 ± 11.2 v. 8.9 ± 5.6 min, respectively) as well as in time to maximal pain reduction (40.4 ± 16.3) versus (33.4 ± 18), respectively.



IN ketamine shows efficacy and safety comparable to IV and IM MO. Given the benefits of this mode of analgesia in emergencies, it should be further studied for potential clinical applications.



Retrospectively registered on 27 June 2016. ClinicalTrials.gov ID: NCT02817477.
Sackler School of Medicine at Tel Aviv University, 55 Haim Levanon Street, Ramat Aviv, 69978, Israel.
Shachar
S
Shimonovich
Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, 64239, Israel.
Roy
R
Gigi
Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, 64239, Israel.
Amir
A
Shapira
Sackler School of Medicine at Tel Aviv University, 55 Haim Levanon Street, Ramat Aviv, 69978, Israel.
Tal
T
Sarig-Meth
Sackler School of Medicine at Tel Aviv University, 55 Haim Levanon Street, Ramat Aviv, 69978, Israel.
Danielle
D
Nadav
Sackler School of Medicine at Tel Aviv University, 55 Haim Levanon Street, Ramat Aviv, 69978, Israel.
Mattan
M
Rozenek
Department of Emergency Medicine, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, 64239, Israel.
Debra
D
West
Department of Emergency Medicine, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, 64239, Israel. dr_halperin@tlvmc.gov.il.
Pinchas
P
Halpern
D000281:Administration, Intranasal; D000293:Adolescent; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D011446:Prospective Studies; D055815:Young Adult
D000700:Analgesics; D007649:Ketamine; D009020:Morphine
Analgesia; Intranasal ketamine; Mass casualty; Morphine; Trauma