Abstract
Objectives
The objective of this study is to describe the clinical use and safety profile of
low-dose ketamine (LDK) (0.1-0.3 mg/kg) for pain management in the emergency department
(ED).
Methods
This was a retrospective case series of consecutive patients given LDK for pain at
a single urban ED between 2012 and 2013. Using a standardized data abstraction form,
2 physicians reviewed patient records to determine demographics, indication, dose,
route, disposition, and occurrence of adverse events. Adverse events were categorized
as minor (emesis, psychomimetic or dysphoric reaction, and transient hypoxia) and
serious (apnea, laryngospasm, hypertensive emergency, and cardiac arrest). Additional
parameters measured were heart rate and systolic blood pressure.
Results
Five hundred thirty patients received LDK in the ED over a 2-year period. Indications
for LDK were diverse. Median patient age was 41 years, 55% were women, and 63% were
discharged. Route of administration was intravenous in 93% and intramuscular in 7%.
Most patients (92%) received a dose of 10 to 15 mg. Comorbid diseases included hypertension
(26%), psychiatric disorder (12%), obstructive airway disease (11%), and coronary
artery disease (4%). There was no significant change in heart rate or systolic blood
pressure. Thirty patients (6%) met our criteria for adverse events. Eighteen patients
(3.5%) experienced psychomimetic or dysphoric reactions. Seven patients (1.5%) developed
transient hypoxia. Five patients (1%) had emesis. There were no cases of serious adverse
events. Agreement between abstractors was almost perfect.
Conclusion
Use of LDK as an analgesic in a diverse ED patient population appears to be safe and
feasible for the treatment of many types of pain.
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Article Info
Publication History
Published online: November 14, 2014
Accepted:
November 7,
2014
Received in revised form:
November 5,
2014
Received:
September 17,
2014
Footnotes
☆Prior presentations: Accepted for presentation, American Society of Regional Anesthesia and Pain Medicine, Annual Pain Medicine Meeting in San Francisco, CA, November 2014.
☆☆Conflicts of interest: The authors report no conflicts of interest.
★Source of support: None.
★★Author contributions: TA, EA, VM, AH, JF, and BF conceived the study and designed the trial. All authors participated in the conduct of the trial, data collection, and organized the work of research assistants. TA, EA, and JF analyzed the data. TA drafted the manuscript, and all authors contributed substantially to its revision. TA takes responsibility for the manuscript as a whole.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
