Sub-dissociative-dose intranasal ketamine for moderate to severe pain in adult emergency department patient

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Abstract

BACKGROUND: There are currently no studies assessing effectiveness of sub-dissociative intranasal (IN) ketamine as the initial analgesic for adult patients in the ED. OBJECTIVE: The study aims to examine the effectiveness of sub-dissociative IN ketamine as a primary analgesic agent for adult patients in the ED. METHOD: This is a prospective, observational study of adult ED patients presenting with severe pain (>/=6 on 11-point scale at triage). IN ketamine dose was 0.7 mg/kg, with secondary dose of 0.5 mg/kg at 15 min if pain did not improve. After 6 months, initial dose was increased to 1.0 mg/kg with the same optional secondary dose. PRIMARY OUTCOMES: The primary outcomes are change in VAS rating at 30 min; percentage of patients reporting clinically significant reduction in VAS (>/=20 mm) at 30 min; dose resulting in clinically significant pain reduction. RESULTS: Of the 72 patients available for analysis, median age was 34.5 years and 64 were men. Median initial VAS rating was 76 mm (interquartile range [IQR]: 65-82). Median total dose of IN ketamine for all patients was 0.98 mg/kg (IQR: 0.75-1.15, range: 0.59-1.57). Median reduction in VAS rating at 30 min was 24 mm (IQR: 2-45). Forty (56 , 95 CI: 44.0-66.7) reported VAS reduction >/=20 mm, these patients having had a total median ketamine dose of 0.94 mg/kg (IQR: 0.72-1.04). CONCLUSION: IN ketamine, at a dose of about 1 mg/kg, was an effective analgesic agent in 56 of study patients. The place of IN ketamine in analgesic guidelines for adults requires further investigation.
Original languageEnglish
Pages (from-to)237 - 242
Number of pages6
JournalEMA - Emergency Medicine Australasia
Volume26
Issue number3
DOIs
Publication statusPublished - 2014

Cite this

@article{b2c7ec6c07f2485aa9f405b5056315e5,
title = "Sub-dissociative-dose intranasal ketamine for moderate to severe pain in adult emergency department patient",
abstract = "BACKGROUND: There are currently no studies assessing effectiveness of sub-dissociative intranasal (IN) ketamine as the initial analgesic for adult patients in the ED. OBJECTIVE: The study aims to examine the effectiveness of sub-dissociative IN ketamine as a primary analgesic agent for adult patients in the ED. METHOD: This is a prospective, observational study of adult ED patients presenting with severe pain (>/=6 on 11-point scale at triage). IN ketamine dose was 0.7 mg/kg, with secondary dose of 0.5 mg/kg at 15 min if pain did not improve. After 6 months, initial dose was increased to 1.0 mg/kg with the same optional secondary dose. PRIMARY OUTCOMES: The primary outcomes are change in VAS rating at 30 min; percentage of patients reporting clinically significant reduction in VAS (>/=20 mm) at 30 min; dose resulting in clinically significant pain reduction. RESULTS: Of the 72 patients available for analysis, median age was 34.5 years and 64 were men. Median initial VAS rating was 76 mm (interquartile range [IQR]: 65-82). Median total dose of IN ketamine for all patients was 0.98 mg/kg (IQR: 0.75-1.15, range: 0.59-1.57). Median reduction in VAS rating at 30 min was 24 mm (IQR: 2-45). Forty (56 , 95 CI: 44.0-66.7) reported VAS reduction >/=20 mm, these patients having had a total median ketamine dose of 0.94 mg/kg (IQR: 0.72-1.04). CONCLUSION: IN ketamine, at a dose of about 1 mg/kg, was an effective analgesic agent in 56 of study patients. The place of IN ketamine in analgesic guidelines for adults requires further investigation.",
author = "Fiona Yeaman and Robert Meek and Diana Egerton-Warburton and Rosengarten, {Pamela Louise} and Andis Graudins",
year = "2014",
doi = "10.1111/1742-6723.12173",
language = "English",
volume = "26",
pages = "237 -- 242",
journal = "EMA - Emergency Medicine Australasia",
issn = "1742-6731",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - Sub-dissociative-dose intranasal ketamine for moderate to severe pain in adult emergency department patient

AU - Yeaman, Fiona

AU - Meek, Robert

AU - Egerton-Warburton, Diana

AU - Rosengarten, Pamela Louise

AU - Graudins, Andis

PY - 2014

Y1 - 2014

N2 - BACKGROUND: There are currently no studies assessing effectiveness of sub-dissociative intranasal (IN) ketamine as the initial analgesic for adult patients in the ED. OBJECTIVE: The study aims to examine the effectiveness of sub-dissociative IN ketamine as a primary analgesic agent for adult patients in the ED. METHOD: This is a prospective, observational study of adult ED patients presenting with severe pain (>/=6 on 11-point scale at triage). IN ketamine dose was 0.7 mg/kg, with secondary dose of 0.5 mg/kg at 15 min if pain did not improve. After 6 months, initial dose was increased to 1.0 mg/kg with the same optional secondary dose. PRIMARY OUTCOMES: The primary outcomes are change in VAS rating at 30 min; percentage of patients reporting clinically significant reduction in VAS (>/=20 mm) at 30 min; dose resulting in clinically significant pain reduction. RESULTS: Of the 72 patients available for analysis, median age was 34.5 years and 64 were men. Median initial VAS rating was 76 mm (interquartile range [IQR]: 65-82). Median total dose of IN ketamine for all patients was 0.98 mg/kg (IQR: 0.75-1.15, range: 0.59-1.57). Median reduction in VAS rating at 30 min was 24 mm (IQR: 2-45). Forty (56 , 95 CI: 44.0-66.7) reported VAS reduction >/=20 mm, these patients having had a total median ketamine dose of 0.94 mg/kg (IQR: 0.72-1.04). CONCLUSION: IN ketamine, at a dose of about 1 mg/kg, was an effective analgesic agent in 56 of study patients. The place of IN ketamine in analgesic guidelines for adults requires further investigation.

AB - BACKGROUND: There are currently no studies assessing effectiveness of sub-dissociative intranasal (IN) ketamine as the initial analgesic for adult patients in the ED. OBJECTIVE: The study aims to examine the effectiveness of sub-dissociative IN ketamine as a primary analgesic agent for adult patients in the ED. METHOD: This is a prospective, observational study of adult ED patients presenting with severe pain (>/=6 on 11-point scale at triage). IN ketamine dose was 0.7 mg/kg, with secondary dose of 0.5 mg/kg at 15 min if pain did not improve. After 6 months, initial dose was increased to 1.0 mg/kg with the same optional secondary dose. PRIMARY OUTCOMES: The primary outcomes are change in VAS rating at 30 min; percentage of patients reporting clinically significant reduction in VAS (>/=20 mm) at 30 min; dose resulting in clinically significant pain reduction. RESULTS: Of the 72 patients available for analysis, median age was 34.5 years and 64 were men. Median initial VAS rating was 76 mm (interquartile range [IQR]: 65-82). Median total dose of IN ketamine for all patients was 0.98 mg/kg (IQR: 0.75-1.15, range: 0.59-1.57). Median reduction in VAS rating at 30 min was 24 mm (IQR: 2-45). Forty (56 , 95 CI: 44.0-66.7) reported VAS reduction >/=20 mm, these patients having had a total median ketamine dose of 0.94 mg/kg (IQR: 0.72-1.04). CONCLUSION: IN ketamine, at a dose of about 1 mg/kg, was an effective analgesic agent in 56 of study patients. The place of IN ketamine in analgesic guidelines for adults requires further investigation.

UR - http://onlinelibrary.wiley.com/doi/10.1111/1742-6723.12173/pdf

U2 - 10.1111/1742-6723.12173

DO - 10.1111/1742-6723.12173

M3 - Article

VL - 26

SP - 237

EP - 242

JO - EMA - Emergency Medicine Australasia

JF - EMA - Emergency Medicine Australasia

SN - 1742-6731

IS - 3

ER -