Abstract
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.
Keywords
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Article info
Publication history
Published online: September 29, 2016
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
