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Is ketamine sedation without local anesthesia sufficient for pediatric laceration repair? A double-blind randomized clinical trial

Published:March 19, 2020DOI:https://doi.org/10.1016/j.ajem.2020.03.030

      Highlights

      • Procedural sedation and analgesia using ketamine have been widely used in emergency department settings during wound repair
      • However, all of these protocols emphasize only the effectiveness and efficacy of ketamine, without mention of the need for local anesthesia.
      • There was no difference in pain and sedation scales between the groups treated with or without local anesthesia and, local anesthesia was not needed

      Abstract

      Purpose

      The objective of this study was to evaluate whether sedation with ketamine without local anesthesia was sufficient in children undergoing primary repair.

      Methods

      Randomized, double-blind trial conducted between December 2013 and October 2016 in a tertiary care pediatric emergency department in Korea. Children aged 1 to 10 years requiring sedation for primary repair were randomly assigned to receive local lidocaine anesthesia with ketamine sedation or local saline injection with ketamine sedation. Children's Hospital of Eastern Ontario Pain Scale scores was recorded during the procedures. The pain scales were recorded by nurses who were blinded to the study drugs, before ketamine sedation, after sedation, during the first injection of the study drugs for wound repair, during the first stitch, and after the procedure.

      Results

      Twenty-five were randomized to receive ketamine sedation with local anesthesia and twenty-two to receive ketamine sedation without local anesthesia. There was no significant difference in pain scale before ketamine sedation (difference (mean): −1.11, CI: −2.78-0.55, P value: 0.18), after sedation (difference (mean): −0.60, CI: −2.20-1.01, P = 0.46), during the first injection of the study drugs for wound repair (difference (mean): −0.03, CI: −0.31-0.25, P = 0.84), during the first stitch (difference (mean): −0.15, CI: 6.19–6.79, P = 0.62), during the primary repair (difference (mean): 0.20, CI: −55-0.95, P = 0.59), and after the procedure (difference (mean): 0.17, CI: −0.48-0.82, P = 0.59).

      Conclusion

      Sedating with ketamine for primary wound repair, there was no difference in pain and sedation scales between the patients treated with or without lidocaine local anesthesia, and local anesthesia was not needed.
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