Abstract
ObjectivesCurrently ketamine is not used often as an analgesic in the emergency department (ED). Nonetheless, it can increase the efficiency of opioids and decrease their side effects. The purpose of this systematic review and meta-analysis was to evaluate whether low-dose ketamine in the ED provides better analgesia with fewer adverse effects.MethodsThe PubMed, EMBASE, and Cochrane Library databases were searched by two reviewers independently (last search performed on January 2016). Data were also extracted independently.ResultsA total of 6 trials involving 438 patients were included in the current analysis. Our subgroup analysis of pain reduction indicates that the favorable effects of ketamine were similar or superior to those of placebo or opioids, although these effects were heterogeneous. However, low-dose ketamine was associated with a higher risk of neurological (relative risk [RR] = 2.17, 95% confidence interval [CI] = 1.37–3.42, P < 0.001) and psychological events (RR = 13.86, 95% CI = 4.85–39.58, P < 0.001). In contrast, the opioid group had a higher risk of major cardiopulmonary events (RR = 0.22, 95% CI = 0.05–1.01, P = 0.05).ConclusionsThe efficiency of ketamine varies depending on the pain site, but low-dose ketamine may be a key agent for pain control in the ED, as it has no side effects. It may also help to reduce the side effects of opioids.
Highlights
Acute pain management is an important issue in the context of symptomatic care of patients in the emergency department (ED)
Low-dose ketamine was associated with a higher risk of neurological and psychological events (RR = 13.86, 95% confidence intervals (CI) = 4.85–39.58, P < 0.001)
The efficiency of ketamine varies depending on the pain site, but low-dose ketamine may be a key agent for pain control in the ED, as it has no side effects
Summary
Acute pain management is an important issue in the context of symptomatic care of patients in the emergency department (ED). Opioids such as hydromorphine and remifentanil have been used to treat patients with acute pain. Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist. It induces the synthesis and release of nitric oxide [2], and binds to μ receptors to increase the effectiveness of opioid-induced signaling [3]. Recent studies have found that ketamine has antiinflammatory effects [4,5]. These actions of ketamine appear to contribute to analgesia against acute pain
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