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Ketamine as a Prehospital Analgesic: A Systematic Review
Akhil Bansal1, Matthew Miller2,3,4, Ian Ferguson2,5,6
1Sydney Medical School, University of Sydney, Camperdown, NSW, Australia.
Prehospital and Disaster Medicine
|April 16, 2020
Summary
Ketamine shows limited evidence as a sole prehospital analgesic but may enhance pain relief and reduce opioid needs when combined with morphine. Further research is recommended for standardized pain assessment and to evaluate ketamine
Area of Science:
- Emergency medicine
- Pharmacology
- Pain management
Background:
- Prehospital analgesia is critical but debated.
- Ketamine, an NMDA receptor antagonist, is used prehospitality despite limited high-level evidence.
- Recommendations exist from military and pain medicine organizations.
Purpose of the Study:
- To review the evidence for ketamine's efficacy and safety in prehospital analgesia.
- To assess ketamine's effectiveness compared to opioids.
- To evaluate ketamine's role in combination therapy.
Main Methods:
- A comprehensive literature review was performed.
- Searches were conducted across multiple electronic medical literature databases.
- Inclusion criteria were applied to identify relevant studies up to October 2018.
Main Results:
- Ten studies met inclusion criteria from 707 unique papers.
- Low-grade evidence supports ketamine alone for analgesia.
- Moderate evidence suggests ketamine with morphine improves efficacy and reduces opioid dosage.
Conclusions:
- Ketamine may be most effective prehospitaly when combined with opioids to lower opioid requirements.
- Standardized pain measurement is needed in future research.
- Further investigation into ketamine's short- and long-term effects is warranted.
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