In adult patients presenting to ED with severe acute pain, is intranasal ketamine as effective as intravenous opiates for pain reduction?

Intranasal ketamine provides pain relief comparable to intravenous morphine for adults with acute severe pain in the emergency department, with a similar side effect profile. This conclusion comes from a systematic review of four studies. However, the generalizability of these findings is limited due to inconsistent study methods, short follow-up, broad exclusion criteria, and small sample sizes. Further research is needed.

Study at a glance

Abstract

This systematic review assessed whether intranasal (IN) ketamine is as effective as intravenous (IV) opiates for adults presenting to the ED with acute severe pain. EMBASE and Medline were searched, using relevant search terms, identifying four studies relevant to our three-part question. Key findings, as well as study weaknesses, were presented in a table. In summary, our results indicate that IN ketamine provides pain relief comparable to IV morphine in this patient cohort, with a similar side effect profile. However, the generalisability of these findings is limited owing to the lack of uniformity in study methodologies, short-term follow-up, broad exclusion criteria, sampling techniques and small sample sizes. Further studies regarding the role of IN ketamine in this setting would be worthwhile.