IN ketamine meta-analysis

Authors: Jana L. Anderson, MD and Lucas Oliveira J. e Silva, MD

Dr. Anderson is a pediatric emergency physician in the Department of Emergency Medicine at Mayo Clinic, Rochester, MN.

Dr. Silva is a research fellow in the Department of Emergency Medicine at Mayo Clinic, Rochester, MN.

The emergency department is the front line for pain control for acute and many times chronic issues.  Given the current climate of opioid use and abuse, alternatives to opioids are being sought.  Recently, the EM research division of Mayo Clinic reviewed and analyzed the current evidence of intranasal (IN) ketamine for pain control in children presenting to the emergency department.  IN ketamine was found to be equally efficacious as IN fentanyl for pain control.  No serious side-effects were found with IN ketamine. The next step is to determine if the benefit of avoiding opioids is worth the non-serious side effects that are higher with IN ketamine.  

Overall summary of our systematic review and meta-analysis:

• Doses used in the studies: 1 mg/kg to 1.5mg/kg IN ketamine vs. 1.5 mcg/kg to 2 mcg/kg IN fentanyl.
• No treatment difference was found at 10 to 15 minutes, 30 minutes and 60 minutes.
• Overall, minor side effects were less common with IN fentanyl.
• No serious side effects occurred with IN ketamine.
• It is unclear whether IN ketamine reduce the rates of rescue analgesia or whether there is benefit in terms of avoiding opioids. This is the area where the next research studies should focus on. 

Please read our article in The American Journal of Emergency Medicine in order to obtain more details about the use of IN ketamine as an alternative to opioids in children having significant pain in the emergency department.