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As
compared to high dose IV opioids, LDK offers less respiratory depression,
addiction and can be recommended safe for painful conditions in ED.
There
is an immense need for the invention of alternative non-opioid analgesics for
the treatment of acute, chronic and refractory pain in the emergency department
(ED).
Ketamine
is a fast-acting non-opioid analgesic which is an N-methyl-d-aspartate (NMDA)
receptor antagonist. It provides safe and effective analgesia. The low dose
ketamine (LDK) (<1 mg/kg) produces sub-dissociative levels of analgesia, and
it had been studied as an alternative and adjunct to opioid analgesics. A total
of 11 studies were considered using LDK, used either alone or in combination
with opioid analgesics in the ED. In these studies, Ketamine was shown to be
effective in treating a variety of painful conditions. When it was given at sub
dissociative doses, it favored the adverse effect profile. A comparison was
also made between LDK and opioids in the ED. Comparison with other opioids
indicated the non-superior analgesic effect of ketamine, but it was comparable
to opioids. LDK causes less respiratory depression, and it had less widespread
potential for abuse. Nursing protocols for the administration of LDK were also
studied in the study.
It was
inferred at last that LDK was highly safe and efficacious alternative and/or
adjunct to opioid analgesics in the ED. However, there is a need for additional
studies to expand and determine its optimal use.
The American Journal of Emergency Medicine
Low dose ketamine use in the emergency department, a new direction in pain management
A Pourmand et al.
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