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Intranasal ketamine for acute pain management in children: A systematic review and meta-analysis

Lucas Oliveira J E Silva1, John Y Lee2, Fernanda Bellolio3

  • 1Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA.

The American Journal of Emergency Medicine
|August 3, 2020
PubMed

Insights

Intranasal ketamine is a viable alternative to intranasal fentanyl for managing acute pediatric pain, showing similar pain reduction and rescue analgesia. While ketamine has more non-serious adverse events, neither drug caused significant sedation or serious adverse events.

Area of Science:

  • Pediatric Emergency Medicine
  • Pain Management
  • Pharmacology

Background:

  • Acute pain in children often requires effective and safe analgesia.
  • Opioid use for pediatric pain carries risks, necessitating exploration of alternatives.
  • Intranasal administration offers a non-invasive route for analgesic delivery.

Purpose of the Study:

  • To compare the efficacy and safety of intranasal analgesic-dose ketamine versus intranasal fentanyl for pediatric acute pain.
  • To evaluate pain reduction, need for rescue analgesia, and adverse events.
  • To assess sedation levels associated with both agents.

Main Methods:

  • Systematic review and meta-analysis following PRISMA guidelines.
  • Searched PubMed, Embase, and Scopus for randomized controlled trials (inception to December 2019).
  • Utilized random-effects models to analyze pain scores, rescue analgesia, adverse events, and sedation.

Main Results:

  • Four trials including 276 patients were analyzed.
  • Intranasal ketamine demonstrated comparable pain reduction to fentanyl across multiple time points.
  • Ketamine was associated with similar rates of rescue analgesia but a higher incidence of non-serious adverse events.
  • No serious adverse events were reported with ketamine; one resolved serious adverse event (hypotension) occurred with fentanyl.
  • No significant sedation was observed with either agent.

Conclusions:

  • Intranasal ketamine presents a potential alternative to opioids for acute pediatric pain management.
  • Its adoption may depend on patient/clinician tolerance of non-serious adverse events and the goal of opioid avoidance.
  • Both agents appear safe regarding serious adverse events and sedation in this context.
Abstract

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