Abstract
Objective
We assessed the analgesic effect and feasibility of low-dose ketamine combined with
a reduced dose of hydromorphone for emergency department (ED) patients with severe
pain.
Methods
This was a prospective observational study of adult patients with severe pain at an
urban public hospital. We administered 0.5 mg of intravenous (IV) hydromorphone and
15 mg of IV ketamine, followed by optional 1 mg hydromorphone IV at 15 and 30 minutes.
Pain intensity was assessed at 12 intervals over 120 minutes using a 10-point verbal
numerical rating scale (NRS). Patients were monitored throughout for adverse events.
Dissociative side effects were assessed using the side effects rating scale for dissociative
anesthetics.
Results
Of 30 prospectively enrolled patients with severe pain (initial mean NRS, 9), 14 reported
complete pain relief (NRS, 0) at 5 minutes; the mean reduction in NRS pain score was
6.0 (SD, 3.2). At 15 minutes, the mean reduction in NRS pain score was 5.0 (SD, 2.8).
The summed pain intensity difference and percent summed pain intensity difference
scores were 25 (95% confidence interval [CI], 21-30) and 58% (95% CI, 49-68) at 30
minutes and 41 (95% CI, 34-48) and 50% (95% CI, 42-58) at 60 minutes, respectively.
Most patients (80%) reported only weak or modest side effects. Ninety percent of patients
reported that they would have the medications again. No significant adverse events
occurred.
Conclusions
Low-dose ketamine combined with a reduced dose hydromorphone protocol produced rapid,
profound pain relief without significant side effects in a diverse cohort of ED patients
with acute pain.
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Article Info
Publication History
Published online: April 22, 2013
Accepted:
February 4,
2013
Received in revised form:
February 2,
2013
Received:
December 14,
2012
Footnotes
☆Author contributions: TA, AH, MS, and BF conceived the study and designed the trial. TA, AH, and BF supervised the conduct of the trial and data collection and organized the work of research assistants. TA, AH, and BF analyzed the data. TA drafted the manuscript, and all authors contributed substantially to its revision. TA takes responsibility for the article as a whole.
☆☆Prior presentations: ACEP Research Forum, Denver, CO, October 8, 2012.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
