23 Jul Ketamine vs Opioids for Acute Pain in the Emergency Department
MedicalResearch.com Interview with:
Dr. Schwarz
Evan Schwarz, MD FACEP, FACMT
Associate Professor of Emergency Medicine
Medical Toxicology Fellowship Director
Section Chief Medical Toxicology
Advisory Dean in the Office of Student Affairs
Division of Emergency Medicine
Washington University School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Ketamine is being increasingly used in the emergency department (ED) for a variety of conditions, including as an analgesic. While its usage continues to increase, there are limited studies evaluating ketamine as an analgesic in the emergency department.
Most of the studies evaluating ketamine utilized it as an adjunct to an opioid, however, multiple recommendations on blogs and other websites recommend ketamine as a single agent. The purpose of the meta-analysis was to compare the analgesic effect of ketamine compared to an opioid in adult patients presenting with acute pain to the ED.
In this study, we found that ketamine was non-inferior to opioids. We also found that the number of severe adverse events to be similar between both groups.
MedicalResearch.com: What should readers take away from your report?
Response: Providers should feel confident that if they are treating patients with an acute painful condition that ketamine will provide similar analgesia as compared to an opioid. This is not to say that opioids should not be used, but that if the provider chooses not to use an opioid, that their patient will still receive adequate analgesia with ketamine.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Further research could also include patients’ and providers’ perspective on receiving ketamine compared to opioids. While pain scores and adverse events were tracked, patients and providers were not surveyed to determine if they were comfortable receiving or administering ketamine, respectively. Future research could also evaluate ketamine as an analgesic in specific conditions. Also the main adverse event form ketamine is emergence reaction and other neuropsychiatric effects. Current research by other providers is examining using ketamine as an infusion as compared to a bolus to determine if that prevents the neuropsychiatric events.
Citation:
Nicholas Karlow MPHS, Charles H. Schlaepfer, Carolyn R. T. Stoll MPH, MSW, Michelle Doering MA, Christopher R. Carpenter MD, Graham A. Colditz DrPH, MD, Sergey Motov MD Joshua Miller MD, Evan S. Schwarz MD
First published: 17 July 2018
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Last Updated on July 23, 2018 by Marie Benz MD FAAD