In this episode, I’ll discuss an article about nebulized vs IV ketamine for analgesia in the ED.
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Subdissociative-dose ketamine can be used for its analgesic effect in acute pain in patients in the ED. Both the IV and nebulized route of administration can be used for ketamine, and a group of authors recently published a double blind double dummy controlled trial comparing ketamine given by these routes for acute pain.
75 patients were given a single dose of 0.3 mg/kg of intravenous ketamine and 75 were given 0.75 mg/kg of nebulized ketamine through a breath-actuated nebulizer.
The authors evaluated the groups for differences in pain scores at 30 minutes post administration, the need for rescue analgesia, adverse event rates, and the difference in pain scores at 15, 30, 60, 90, and 120 minutes.
The baseline mean pain scores was 8.2 out of 10 for both groups. This decreased to 3.6 in the IV group and 3.8 in the nebulized group at 30 minutes for a mean difference of 0.23. This difference did not meet the prespecified criteria for a clinically important difference.
There were also no differences in changes vital signs between groups that the authors felt was clinically concerning, and no serious adverse events occurred in either group during the study.
The authors concluded:
We found no difference between the administration of IV and nebulized ketamine for the short-term treatment of moderate to severe acute pain in the ED, with both treatments providing a clinically meaningful reduction in pain scores at 30 minutes.
One notable advantage to nebulized ketamine is that it can be delivered without first establishing IV access, and this may be desirable in patients who present to the ED with acute pain but do not otherwise have a need for IV access. Previous studies have found high rates of unnecessary peripheral IV access and authors have advocated for using alternative routes of medication administration to reduce the need for peripheral IV insertion.
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