Brief ReportLow-dose ketamine analgesia: patient and physician experience in the ED☆
Introduction
Ketamine (Ketalar) has been used extensively in the emergency department (ED) for conscious sedation and rapid sequence induction [1]. It has been more commonly used in pediatric than adult patients by emergency physicians. Ketamine, when used at lower subassociative dosage (0.2 mg/kg IV), provides analgesia with less pronounced psychoactive side effects [2]. As such, ketamine may represent an alternative agent to opioids for patients with acute or chronic pain and may be advantageous for those who are opioid tolerant [3]. We conducted a survey study of ED patients receiving low-dose ketamine (LDK) specifically for analgesia to determine (1) level of pain reduction, (2) overall satisfaction with ketamine, (3) adverse side effects, and (4) willingness to be treated with ketamine again. We also surveyed their treating physicians regarding their satisfaction with LDK as an analgesic and potential reasons why ketamine is not commonly used for this indication in the ED.
Section snippets
Methods
This was an observational case series performed during April 2011 at an urban university-based medical center ED serving a community of 1.5 million. It is a level 1 trauma center and also serves as a tertiary referral center to central and northern California. The ED has an annual volume of 70 000 patient visits and an associated emergency medicine residency program. Patients were eligible for the study if they were aged 18 years or older and were to receive ketamine for any reason. Exclusion
Results
Over a 1-month period, 25 patients were identified, and 24 were enrolled. The average age for the study group was 39.8 ± 12.4 years, with 16 women (64%) and 9 men (36%). With regard to race, there were 6 black (24%), 5 Hispanic (20%), 14 white (56%), but no Asian patients. Twenty-one patients received ketamine specifically for analgesia, and 3 received ketamine for sedation. One received ketamine for rapid sequence intubation and was not enrolled. The average dose of ketamine was 22.2 ± 11.2
Discussion
Patients with acute and chronic nonmalignant pain often have opioid tolerance from prolonged use of prescription and nonprescription opioid analgesics [3]. These patients may also have genetic polymorphism with resultant baseline resistance to opioid analgesia [4], [5]. They may require multiple and higher than normal doses of opioids to achieve acceptable analgesia. High doses of opioid analgesics for these patients should be avoided whenever possible. Furthermore, parenteral opioid use in a
Limitations
This study has several limitations. First, it is a small sample of patients with limited power. It is a survey study with subjective answers regarding pain perception and satisfaction and subject to variability. Patients' perception of pain may differ widely from a pharmacogenetic and temporal standpoint, and this could have affected our results. Even if this study were randomized and double blinded, patients' report of pain would still be subjective. We do believe, however, that this is the
Conclusion
Low-dose ketamine as an adjuvant to opioids may decrease patients' perception of pain. Most patients and physicians were satisfied with ketamine for this purpose and would use it again. Whites were least satisfied with the use of ketamine for analgesia. Physicians believed that ketamine is generally underused in adult patients.
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2021, Australasian Emergency CareCitation Excerpt :However, there was significant heterogeneity amongst studies. Patient satisfaction with treatment was the most common measure evaluated (n = 39, 70.9%) [4,22–25,32,35,36,38–40,42–45,47–49,51–53,55–57,59–61,63,64,66–71,73–75], followed by desire for more pain medication (n = 13, 23.6%) [20,23,24,26–29,31,35,50,59,66,70], desire for same treatment in the future (n = 12, 21.8%) [20,21,23,24,31,35,37,47,50,65,68,70], and satisfaction with overall ED experience (n = 3, 5.4%) [30,33,34]. Many studies used more than one patient satisfaction question.
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2017, American Journal of Emergency MedicineCitation Excerpt :Within the studies reviewed, 1187 patients received LDK. The most common adverse effects were dizziness, nausea, vomiting, and mild neuropsychological reactions such as hallucinations or agitation [25-26,28-34]. Almost all of these adverse effects resolved spontaneously.
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Presented at the Society for Academic Emergency Medicine Western Regional Meeting, Las Vegas, Nevada, March 16, 2012.