Authors: Tommy Nguyen, Mo Mai, Amulya Choudhary, Slavic Gitelman, Jefferson Drapkin, Antonios Likourezos, Sarah Kabariti, Rukhsana Hossain, Karina Kun, Ankit Gohel, Patrizia Niceforo, Michael Silver, Sergey Motov
Published in: Annals of Emergency Medicine, May 2, 2024
Conclusion:
There was no significant difference between the administration of intravenous and nebulized ketamine for the short-term treatment of moderate to severe acute pain in the ED. Both treatments provided a clinically meaningful reduction in pain scores at 30 minutes, demonstrating the potential effectiveness of nebulized ketamine as an alternative analgesic option.
Methods:
- Study Design: Prospective, randomized, double-blind, double-dummy controlled clinical trial.
- Population: Adult patients (aged 18 and older) with a numerical rating scale (NRS) pain score of ≥5.
- Interventions:
- Group 1: Single dose of 0.3 mg/kg of intravenous (IV) ketamine.
- Group 2: Single dose of 0.75 mg/kg of nebulized ketamine via a breath-actuated nebulizer.
- Outcomes:
- Primary Outcome: Difference in pain scores on the NRS between groups at 30 minutes post-medication administration.
- Secondary Outcomes:
- Need for rescue analgesia.
- Occurrences of adverse events in each group.
- Differences in pain scores at 15, 30, 60, 90, and 120 minutes.
Results:
- Sample Size: 150 patients (75 per group).
- Baseline Pain Scores: Mean pain scores on the NRS were 8.2 in both groups.
- Primary Outcome:
- At 30 minutes, pain scores decreased to:
- IV ketamine group: 3.6
- Nebulized ketamine group: 3.8
- Mean difference between groups: 0.23 (95% CI -1.32 to 0.857), which is not statistically significant.
- Secondary Outcomes:
- No significant differences in the need for rescue analgesia or pain scores at other time intervals.
- No clinically concerning changes in vital signs.
- No serious adverse events were reported in either group throughout the study period.