Is There a Role for Intravenous Sub-Dissociative-Dose Ketamine Administered as an Adjunct to Opioids or as a Single Agent for Acute Pain Management in the ED?

Sub-dissociative dose ketamine (low-dose ketamine) is useful and safe to use alone or in combination with opioid analgesics for the treatment of acute pain in the Emergency Department (ED) and in pre-hospital settings. Its use is associated with higher rates of minor but well tolerated adverse side effects. In order to identify manuscripts for review a PubMed query was carried out by using the following terms: “low-dose ketamine, “sub-dissociative dose ketamine” “acute pain in the ED”, and “analgesia in the ED”. Only randomized controlled trials, systematic reviews, meta-analyses and observational studies were included. Case series and reports were excluded as well as studies evaluating the intranasal route of ketamine administration (due to dosing variability.) Systematic reviews with inconclusive results (neither
supporting nor refuting the use low-dose ketamine) were also excluded. The search was limited to the English language, and included only adult human studies in patients not older than 65 years of age. We limited the search to include studies done only in the five years between 2010-2015. Based on these search parameters 8 studies were included in the final analysis.

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References and Literature Grading (PDF)