Administration of Nebulized Ketamine for Managing Acute Pain in the Emergency Department: A Case Series

Jefferson Drapkin,Rukhsana Hossain,Aidin Masoudi,Antonios Likourezos,Mahlaqa Butt,Sergey Motov

doi:10.5811/cpcem.2019.10.44582

Jefferson Drapkin, Rukhsana Hossain + Show 4 more

Open Access

https://doi.org/10.5811/cpcem.2019.10.44582

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Abstract

Ketamine administration in sub-dissociative doses in the emergency department (ED) results in effective pain relief in patients with acute traumatic and non-traumatic pain, chronic pain, and opioid-tolerant pain. This case series describes five adult ED patients who received nebulized ketamine for predominantly acute traumatic pain. Three patients received nebulized ketamine at 1.5 milligrams per kilogram (mg/kg) dose, one patient at 0.75 mg/kg, and one patient at 1 mg/kg. All five patients experienced a decrease in pain from the baseline up to 120 minutes. The inhalation route of ketamine delivery via breath-actuated nebulizer may have utility for managing pain in the ED.

Highlights

Ketamine is a non-competitive N-methyl-D-aspartate/glutamate receptor complex antagonist that decreases pain by diminishing central sensitization, hyperalgesia, and “wind-up” phenomenon at the level of the spinal cord and central nervous system.[1]
The nebulization of analgesics in the emergency department (ED) provides rapid, effective, and titratable analgesic delivery. It results in less painful methods of analgesic delivery, minimizes analgesic toxicity and side effects, and improves overall management of a variety of painful conditions in the ED.[6]
CASE SERIES We describe five patients, ages 30-54, who presented to the ED with acute painful conditions: four patients with traumatic musculoskeletal pain, and one with abdominal pain (Table 1)

Summary

Case Series

Administration of Nebulized Ketamine for Managing Acute Pain in the Emergency Department: A Case Series. Ketamine administration in sub-dissociative doses in the emergency department (ED) results in effective pain relief in patients with acute traumatic and non-traumatic pain, chronic pain, and opioidtolerant pain. This case series describes five adult ED patients who received nebulized ketamine for predominantly acute traumatic pain. Three patients received nebulized ketamine at 1.5 milligrams per kilogram (mg /kg) dose, one patient at 0.75 mg/kg, and one patient at 1 mg/kg. The inhalation route of ketamine delivery via breath-actuated nebulizer may have utility for managing pain in the ED. The inhalation route of ketamine delivery via breath-actuated nebulizer may have utility for managing pain in the ED. [Clin Pract Cases Emerg Med. 2020;4(1):16–20.]

INTRODUCTION

Administration of Nebulized Ketamine for Managing Acute Pain in the ED

Patient number

DISCUSSION

Fatigue min