Lana Djenic
Ketamine hydrochloride is currently labelled for use as an anesthetic, however it is used off-label as an analgesic under physician supervision. Tactical Combat Casualty Care (TCCC) guidelines recommend use of ketamine as an option to manage moderate to severe pain for casualties in or at risk for hemorrhagic shock or respiratory distress. The purpose of this evidence-based practice project was to identify and summarize best evidence related to administration of ketamine for acute pain in the pre-hospital and emergency department (ED) settings. PICO Questions: 1. In adult patients (P), in the pre-hospital and/or ED settings, how does ketamine (I) compared to other pain medications or no pain medication © influence pain relief (O)? 2. In adult trauma patients, in the pre-hospital and ED settings (P), what is the recommended dosing (IN, IM, IV) of ketamine (I) for the relief of moderate to severe acute pain (O)?
We conducted an interim analysis of the results from 7 RCTs. A total of 411 patients from seven studies were included. Ketamine doses ranged from 0.2 – 1.00 mg/kg, with median dosage of 0.3 mg/kg (IQR 1st & 3rd Quartiles = 0.23 – 0.30). Between-groups differences for NRS or VAS scores assessed 15 minutes to 48 hours post-medication administration ranged from clinically significant to non-significant, with study effect sizes ranging from -1.49 – 1.01. The pooled effect size for placebo-controlled studies (n = 2; N = 121) was -0.78 (95% CI = -0.41 – -0.43). For morphine comparison studies (n = 5; N = 290), the pooled effect size equaled -.02 (95%CI = -0.26 – 0.22). Results imply ketamine is efficacious and non-inferior to other pain medications. Results suggest a dosage of 0.3 mg/kg is adequate in the treatment of acute pain in the ED, however further studies are needed to determine optimal dosages.
Comments
Interesting research, especially in light of the opioid epidemic. Thank you for sharing this work. —Jeanette Herman
Good job, especially in making clear right from the beginning that the ultimate goal of this line of research is FDA approval for this use — a very important practical application of this work. — Rob Reichle
Thank you very much! — Lana Djenic