NDLI: Sub-dissociative-dose intranasal ketamine for moderate to severe pain in adult emergency department patients.

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

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Yeaman, Fiona Meek, Robert Egerton-Warburton, Diana Rosengarten, Pamela Graudins, Andis
Description	Country affiliation: Australia Author Affiliation: Yeaman F ( Southern Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.)
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.
File Format	HTM / HTML
ISSN	17426731
Issue Number	3
Volume Number	26
e-ISSN	17426723
Journal	Emergency Medicine Australasia
Language	English
Publisher	Wiley-Blackwell
Publisher Date	2014-06-01
Publisher Place	Australia
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Emergency Medicine Anesthetics, Dissociative Administration & Dosage Emergency Service, Hospital Ketamine Pain Management Methods Pain Drug Therapy Administration, Intranasal Adult Dose-response Relationship, Drug Statistics & Numerical Data Female Humans Male Middle Aged Pain Measurement Drug Effects Prospective Studies Journal Article
Content Type	Text
Resource Type	Article
Subject	Emergency Medicine

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