Dose Finding Ketamine ED pain

Incomplete

Lovett S, et al. "A randomized, noninferiority, controlled trial of two doses of intravenous subdissociative ketamine for analgesia in the emergency department". Acad Emerg Med. 2020. Online ahead of print:.
PubMed • Full text

Clinical Question

In adult patients with moderate to severe pain in the ED that receive a sub-dissociative dose of ketamine, is a lower dose of 0.15 mg/kg non-inferior to 0.30 mg/kg?

Bottom Line

The lower dose of 0.15 mg/kg was non-inferior to the higher dose of 0.30 mg/kg

Guidelines

American Academy of Emergency Medicine White Paper on Acute Pain Management in the Emergency Department (adapted, 2017):

Non-opioid Pharmacological Management:

• Non-steroidal anti-inflammatory drugs (NSIAD) at lowest effective doses
  • Topical NSAIDs or other topical analgesics (eg. lidocaine patches) if systemic NSAID contraindicated
• Oral/rectal acetaminophen
• Sub-dissociative dose ketamine (SDK) used alone or as part of a multimodal analgesic approach
• consider intravenous lidocaine for specific conditions (renal colic, herpetic/post-herpetic neuralgia) in patients without contraindications
• trigger point injections with local anesthetics
• nitrous oxide, alone or as an adjunct

Design

• Randomized, prospective, double-blinded, noninferiority trial
• N=98
  • Low dose ketamine 0.15 mg/kg (n=49)
  • High dose ketamine 0.30 mg/kg (n=49)
• Setting:
• Enrollment:
• Mean follow-up:
• Analysis:
• Primary Outcome: Change in 11-point numeric rating scale (NRS) pain score at 30 minutes

Population

Inclusion Criteria

• age 18 to 59 years
• presenting to the ED
• acute moderate to severe pain

Baseline Characteristics

BLANK Group displayed

• Demographics:
• Physiologic parameters:
• Anthropomorphics: Weight
• Labs:
• Site of infection

Interventions

• "Low" dose ketamine of 0.15 mg/kg IV over 15 minutes
• "High" dose ketamine of 0.30 mg/kg IV over 15 minutes

Outcomes

Comparisons are 0.15 mg/kg ketamine vs. 0.30 mg/kg ketamine.

Primary Outcomes

mean NRS at 30 minutes

4.7 vs. 5 (mean difference = 0.4, 95% CI = -0.8 to 1.5)

Further Reading

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