Ketamine for prehospital trauma analgesia in a low-resource rural trauma system: a retrospective comparative study of ketamine and opioid analgesia in a ten-year cohort in Iraq.

Ole Kristian Losvik,Mudhafar Kareem Murad,Eystein Skjerve,Hans Husum

doi:10.1186/s13049-015-0176-1

Abstract

BackgroundOpioid analgesics are used in most trauma systems, and only a few studies report on the use of ketamine for prehospital analgesia. In a low-cost rural trauma system in Iraq paramedics have been using prehospital ketamine analgesia for ten years. This study aims to evaluate the effects of prehospital analgesia on physiologic trauma severity indicators and compare the effect of ketamine and pentazocine on those indicators.MethodsThe investigation was conducted as a retrospective cohort study with parallel group design. Three subsamples of trauma patients were compared: no analgesia (n = 275), pentazocine analgesia (n = 888), and ketamine analgesia (n = 713). Physiologic severity scores were calculated based on rated values for respiratory rate, blood pressure, and consciousness. The associations between outcomes and explanatory variables were assessed using a generalized linear model.ResultsParamedic administration of analgesia was associated with a better physiologic severity score (PSS) outcome (p = 0.01). In the two subsamples receiving analgesia significantly better outcomes were observed for respiration (p < 0.0001) and systolic blood pressure (p < 0.0001). In patients with Injury Severity Score >8 ketamine was associated with a significantly better effect on the systolic blood pressure compared to opioid analgesia (p = 0.03).ConclusionPrehospital analgesia for trauma victims improves physiologic severity indicators in a low-resource trauma system. Compared to pentazocine, ketamine was associated with improved blood pressure for patients with serious injuries. In a low-resource setting, ketamine seems to be a good choice for prehospital analgesia in trauma patients.

Highlights

Opioid analgesics are used in most trauma systems, and only a few studies report on the use of ketamine for prehospital analgesia
Respiratory rate The generalized linear model (GLM) analysis showed that analgesia was associated with a positive effect on respiratory rate score, while no difference was found between pentazocine and ketamine (Table 5)
Increasing in-field response time was associated with a worse respiratory rate, while increasing total prehospital time was associated with a better respiratory rate

Summary

Introduction

Opioid analgesics are used in most trauma systems, and only a few studies report on the use of ketamine for prehospital analgesia. In a low-cost rural trauma system in Iraq paramedics have been using prehospital ketamine analgesia for ten years. This study aims to evaluate the effects of prehospital analgesia on physiologic trauma severity indicators and compare the effect of ketamine and pentazocine on those indicators. In most prehospital trauma systems, opioid analgesics have been the preferred choice over the last decades. The therapeutic range is narrow in opioids; there is the risk of accidental overdose that can cause respiratory depression, hypotension and the loss of protective airway reflexes. Ketamine hydrochloride is a non-opioid potent analgesic used for anesthesia for decades. Ketamine does not affect respiration or laryngeal reflexes; under ketamine analgesia and anesthesia, patients breathe spontaneously and maintain airway control [2]

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