title: A prospective randomized, double-dummy trial comparing IV push low dose ketamine to short infusion of low dose ketamine for treatment of  pain in the ED.
abstract: OBJECTIVE
  Compare adverse effects and analgesic efficacy of low-dose ketamine for acute pain in the ED administered either by single intravenous push (IVP) or short infusion (SI).
  
  
  METHODS
  Patients 18-65, presenting to ED with acute abdominal, flank, or musculoskeletal pain with initial pain score≥5, were randomized to ketamine 0.3mg/kg by either IVP or SI with placebo double-dummy. Adverse effects were evaluated by Side Effects Rating Scale for Dissociative Anesthetics (SERSDA) and Richmond Agitation-Sedation Scale (RASS) at 5, 15, 30, 60, 90, and 120min post-administration; analgesic efficacy was evaluated by Numerical Rating Scale (NRS).
  
  
  RESULTS
  48 patients enrolled in the study. IVP group had higher overall rates of feeling of unreality on SERSDA scale: 92% versus 54% (difference 37.5%; p=0.008; 95% CI 9.3-59.5%). At 5min median severity of feeling of unreality was 3.0 for IVP versus 0.0 for SI (p=0.001). IVP also showed greater rates of sedation on RASS scale at 5min: median RASS -2.0 versus 0.0 (p=0.01). Decrease in mean pain scores from baseline to 15min was similar across groups: 5.2±3.53 (95% CI 3.7-6.7) for IVP; 5.75±3.48 (95% CI 4.3-7.2) for SI. There were no statistically significant differences with respect to changes in vital signs and need for rescue medication.
  
  
  CONCLUSIONS
  Low-dose ketamine given as a short infusion is associated with significantly lower rates of feeling of unreality and sedation with no difference in analgesic efficacy in comparison to intravenous push.
authors.affiliation: Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA. Electronic address: smotov@maimonidesmed.org.
authors.forename: Sergey
authors.initials: S
authors.lastname: Motov
authors.affiliation: Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA.
authors.forename: Mo
authors.initials: M
authors.lastname: Mai
authors.affiliation: Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA.
authors.forename: Illya
authors.initials: I
authors.lastname: Pushkar
authors.affiliation: Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA.
authors.forename: Antonios
authors.initials: A
authors.lastname: Likourezos
authors.affiliation: Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA.
authors.forename: Jefferson
authors.initials: J
authors.lastname: Drapkin
authors.affiliation: Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Yasavolian
authors.affiliation: Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Brady
authors.affiliation: Office of Research Administration, Maimonides Medical Center, Brooklyn, NY, USA; Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Homel
authors.affiliation: Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Fromm
mesh_terms: D059787:Acute Pain / Q000188:drug therapy*; D000328:Adult; D000700:Analgesics / Q000008:administration & dosage* / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007649:Ketamine / Q000008:administration & dosage* / Q000627:therapeutic use*; D008297:Male; D010147:Pain Measurement; D011446:Prospective Studies; D016896:Treatment Outcome; D014481:United States
chemical_list: D000700:Analgesics; D007649:Ketamine
keywords: Analgesia; Emergency department; Infusion; Ketamine