Low-Dose Ketamine for Acute Pain: A Narrative Review
Authors: Robert G Fuller, Evan M Kikla, Andrew P W Fawcett, John D Hesling, Sean Keenan, Kathleen M Flarity, Michael S Patzkowski, Michael D April, Vikhyat S Bebarta, Steven G Schauer
Journal: American Journal of Emergency Medicine, September 2024
Conclusions: LDK is a safe and effective treatment option for acute pain in both prehospital and ED settings. It can be used alone or as an adjunct to opioids, reducing the need for higher opioid doses. LDK is available in various formulations, including intramuscular, intravenous, and intranasal, which enhances its versatility in acute pain management. As the landscape of pain treatment evolves, LDK represents a promising option, particularly in scenarios where opioid use may be limited or undesirable.
Methods: A scoping narrative review was conducted to evaluate the efficacy of LDK for acute pain management, focusing on both prehospital and ED settings, including civilian and military contexts. PubMed was used to identify prospective and retrospective studies published in English before January 30, 2024. Only clinical and observational studies were included, and the PRISMA-ScR checklist was followed to ensure a structured review process.
Results:
- A total of 249 publications were initially identified, with 71 sought for detailed review. Ultimately, 64 studies were included for analysis, comprising 21 studies from prehospital settings (including 4 randomized clinical trials) and 43 from ED settings (including 28 randomized clinical trials).
- The studies collectively demonstrate that LDK is non-inferior to opioids in treating acute pain when used alone. As an adjunct to opioids, LDK can reduce opioid consumption, demonstrating an opioid-sparing effect.
- Ketamine doses of less than 0.5 mg/kg were associated with minimal side effects, making it a viable alternative for safe pain management.