Efficacy and Safety of Intranasal Ketamine for Acute Pain Management in the Emergency Setting: A Systematic Review and Meta-Analysis

Summary & key facts

Researchers reviewed seven carefully controlled trials that tested intranasal ketamine for sudden (acute) pain in adults who came to the emergency department. The trials included about 1,760 people. Overall, intranasal ketamine worked about as well as standard intravenous pain medicines or placebo for reducing pain up to one hour after treatment. Only mild and short-lived side effects were seen. The authors say intranasal ketamine could be an option for adults in the emergency department, especially when putting a needle into a vein is slow or hard, but the evidence comes just from these specific trials and settings.

Key facts:

• The review combined results from seven randomized trials with about 1,760 adults who had acute pain in the emergency department.
• Across time points from five minutes to 60 minutes after treatment, pain scores after intranasal ketamine were about the same as after standard intravenous pain medicines or placebo.
• Similar numbers of people needed extra pain medicine after intranasal ketamine as after intravenous drugs, although the trials showed quite a bit of variation.
• Only mild side effects were reported with intranasal ketamine. Common, short-lived effects mentioned included dizziness, nausea, tiredness, and a brief sense of euphoria or feeling 'spacey.'
• The review looked only at adults in emergency departments and only included randomized trials published in English, so its results may not apply to children or other medical settings.

Abstract

= 70%). Only mild adverse effects were observed in patients who received IN ketamine. Our results suggest that IN ketamine is non-inferior to IV analgesics and may have a role in acute pain management among adults in the ED.

Topics

Anesthesia and Pain Management Anesthesia and Sedative Agents Pediatric Pain Management Techniques

Categories

Anesthesiology and Pain Medicine Health Sciences Medicine

Tags

Adverse effect Alternative medicine Anesthesia Confidence interval Emergency department Internal medicine Ketamine Medicine Meta-analysis Odds ratio Pathology Placebo Psychiatry

Substances

Ketamine