Comparison of Nebulized Ketamine to Intravenous Subdissociative Dose Ketamine for Treating Acute Painful Conditions in the Emergency Department: A Prospective, Randomized, Double-Blind, Double-Dummy Controlled Trial.
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
Annals of emergency medicine October 1, 2024 DOI: 10.1016/j.annemergmed.2024.03.024 via PubMed
Summary
AI-generated from the abstractIn emergency department patients with acute pain, intravenous and nebulized ketamine provide similar short-term pain relief. A randomized trial compared a single dose of 0.3 mg/kg intravenous ketamine to 0.75 mg/kg nebulized ketamine in 150 adults with pain scores of 5 or higher on a 0–10 scale. At 30 minutes, mean pain scores fell from 8.2 to 3.6 (intravenous) and 3.8 (nebulized), a difference of 0.23 points that is neither clinically nor statistically significant. No serious adverse events occurred. Both routes offer a meaningful reduction in moderate to severe acute pain without safety concerns.
Study at a glance
| Characteristics | Randomized controlled trial Double-blind Peer reviewed |
|---|---|
| Sample size | 150 |
| Population | Adult emergency department patients with acute painful conditions and a numerical rating scale pain score of ≥5 |
| Intervention | Nebulized ketamine |
| Dose | 0.3 mg/kg intravenous, 0.75 mg/kg nebulized |
| Duration | Single dose, outcomes measured up to 120 minutes |
| Keywords | Pain management Ketamine therapy Emergency medicine Medical research Drug delivery systems |
| Citations | 11 |
| Key finding | Intravenous and nebulized ketamine produced equivalent reductions in pain scores at 30 minutes, with no clinically important difference between the two routes. |
Abstract
We aimed to assess and compare the analgesic efficacy and adverse effects of intravenous subdissociative-dose ketamine to nebulized ketamine in emergency department (ED) patients with acute painful conditions. We conducted a prospective, randomized, double-blind, double-dummy clinical trial in adult patients (ages 18 and older) with a numerical rating scale pain score of ≥5. We randomized subjects to receive either a single dose of 0.3 mg/kg of intravenous (IV) ketamine or 0.75 mg/kg of nebulized ketamine through a breath-actuated nebulizer. Primary outcome was the difference in pain scores on the numerical rating scale between groups at 30 minutes postmedication administration. The secondary outcomes included the need for rescue analgesia, occurrences of adverse events in each group, and the difference in pain scores at 15, 30, 60, 90, and 120 minutes. We calculated a 95% confidence interval (CI) for a mean difference at 30 minutes, with a minimum clinically important difference set at 1.3 points. We enrolled 150 subjects (75 per group). Mean pain scores through numerical rating scale were 8.2 for both groups at baseline, which decreased to 3.6 and 3.8 at 30 minutes, yielding a mean difference of 0.23 (95% CI -1.32 to 0.857). We observed no clinically concerning changes in vital signs. No serious adverse events occurred in any of the groups throughout the study period. We found no difference between the administration of IV and nebulized ketamine for the short-term treatment of moderate to severe acute pain in the ED, with both treatments providing a clinically meaningful reduction in pain scores at 30 minutes.