title: The Use of Ketamine for Acute Treatment of Pain: A Randomized, Double-Blind, Placebo-Controlled Trial.
abstract: BACKGROUND
  Pain is one of the most common reasons for emergency department (ED) visits in the United States. Ketamine is a sedative with N-methyl-D-aspartate (NMDA) receptor antagonism. Recent literature has suggested that the use of subdissociative dose ketamine (SDDK) may be safe and effective for acute pain.
  
  
  OBJECTIVE
  The objective of our study was to evaluate ketamine in subdissociative doses as an adjunct for acute pain in the ED.
  
  
  METHODS
  This was a single-center, prospective, randomized, double-blind, placebo-controlled trial that evaluated the use of SDDK in adult patients who presented to the ED with acute pain. Patients received ketamine 0.3 mg/kg via intravenous piggyback over 15 min or placebo. Morphine 0.1 mg/kg intravenous push was administered with the study interventions. The primary outcome was the patient's pain score 15 min after initiation of the intervention. Secondary outcomes included adverse events, consumption of rescue analgesia, patient's length of stay, and patient satisfaction with treatment.
  
  
  RESULTS
  Thirty patients were enrolled in each group. Median pain scores in patients who received ketamine were lower than in controls at 15 min (3.5 [interquartile range {IQR} 1.0-7.3 vs. 6.0 [IQR 4.0-9.0], respectively; p = 0.018). No serious adverse events occurred. No difference was detected in the amount of rescue analgesia used or in length of stay. Patients who received ketamine reported a higher mean satisfaction score with their pain management (8.57 [standard deviation {SD} 2.1]) than patients who received placebo (6.05 [SD 2.6]; p = 0.01).
  
  
  CONCLUSIONS
  When used as an adjunct, SDDK administered at 0.3 mg/kg over 15 min resulted in safe and effective analgesia for ≤30 min in patients who presented with acute pain in the ED.
authors.affiliation: Arnold and Marie Schwartz College of Pharmacy, Long Island University, Brooklyn, New York; Department of Pharmacy, Division of Pharmacotherapy Services, The Brooklyn Hospital Center, Brooklyn, New York; Department of Emergency Medicine, The Brooklyn Hospital Center, Brooklyn, New York.
authors.forename: Billy
authors.initials: B
authors.lastname: Sin
authors.affiliation: Department of Emergency Medicine, The Brooklyn Hospital Center, Brooklyn, New York.
authors.forename: Tamara
authors.initials: T
authors.lastname: Tatunchak
authors.affiliation: Department of Emergency Medicine, The Brooklyn Hospital Center, Brooklyn, New York.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Paryavi
authors.affiliation: Department of Emergency Medicine, The Brooklyn Hospital Center, Brooklyn, New York.
authors.forename: Maria
authors.initials: M
authors.lastname: Olivo
authors.affiliation: Department of Emergency Medicine, The Brooklyn Hospital Center, Brooklyn, New York.
authors.forename: Usman
authors.initials: U
authors.lastname: Mian
authors.affiliation: Department of Emergency Medicine, The Brooklyn Hospital Center, Brooklyn, New York.
authors.forename: Josel
authors.initials: J
authors.lastname: Ruiz
authors.affiliation: Arnold and Marie Schwartz College of Pharmacy, Long Island University, Brooklyn, New York.
authors.forename: Bupendra
authors.initials: B
authors.lastname: Shah
authors.affiliation: Department of Emergency Medicine, The Brooklyn Hospital Center, Brooklyn, New York.
authors.forename: Sylvie
authors.initials: S
authors.lastname: de Souza
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000494:pharmacology / Q000627:therapeutic use; D004311:Double-Blind Method; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006801:Humans; D007649:Ketamine / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods* / Q000592:standards*; D010147:Pain Measurement / Q000379:methods; D010919:Placebos; D011446:Prospective Studies; D018709:Statistics, Nonparametric
chemical_list: D000700:Analgesics; D010919:Placebos; D007649:Ketamine
keywords: acute pain; analgesia; ketamine; subdissociative dose