Morning Report

Morning Report: Ketamine for ED Pain Control?

Presenter: Paarth Raj D.O., Brett Schupack MS-IV Touro COM-NY

Topic: Low dose ketamine is comparable to opioids for acute pain management in the emergency department.

Summary

Unintentional opioid overdoses have surpassed MVAs as the leading cause of injury death in the U.S. Emergency physicians should look for alternatives in treating acute pain in the ED. Low dose ketamine (LDK) (0.3 mg/kg) provides similar maximum pain reduction to morphine (0.1 mg/kg) in a wide variety of acute pain conditions as measured by numeric rating scale. Additionally, ketamine has shown to be safe in a recent 500 patient study where it was used for a broad range of complaints of diverse comorbidities. There were no serious adverse outcomes.

Learning Points:

  • The suggested dose of ketamine for analgesia is 0.1 – 0.3 mg/kg IV, however there is no well-established dose.
  • More frequent repeat doses of ketamine may be required to sustain analgesia.
  • Emergence reactions appear to be less common at analgesic doses, however they can be effectively treated with benzodiazepines

EBM Article:

Miller, J. P., Schauer, S. G., Ganem, V. J., & Bebarta, V. S. (2015). Low-dose ketamine vs morphine for acute pain in the ED: A randomized controlled trial. The American Journal of Emergency Medicine, 33(3), 402-408. doi:http://dx.doi.org/10.1016/j.ajem.2014.12.058

Ahern TL, et al. The first 500: initial experience with widespread use of low-dose ketamine for acute pain management in the ED. Am J Emerg Med. 2015 Feb;33(2):197-201.

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