Ketamine for the treatment of prehospital acute pain: a systematic review of benefit and harm
Background Few publications have addressed prehospital use of ketamine in analgesic doses. We aimed to assess the effect and safety profile of ketamine compared with other analgesic drugs (or no drug) in adult prehospital patients with acute pain.Methods A systematic review of clinical trials assess...
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BMJ Publishing Group
2020-11-01
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| author | Leif Rognås Lasse Raatiniemi Mårten Sandberg Per Kristian Hyldmo Poul Kongstad Kristian Dahl Friesgaard Robert Larsen Vidar Magnusson Jouni Kurola Marius Rehn Gunn Elisabeth Vist |
| author_facet | Leif Rognås Lasse Raatiniemi Mårten Sandberg Per Kristian Hyldmo Poul Kongstad Kristian Dahl Friesgaard Robert Larsen Vidar Magnusson Jouni Kurola Marius Rehn Gunn Elisabeth Vist |
| author_sort | Leif Rognås |
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| description | Background Few publications have addressed prehospital use of ketamine in analgesic doses. We aimed to assess the effect and safety profile of ketamine compared with other analgesic drugs (or no drug) in adult prehospital patients with acute pain.Methods A systematic review of clinical trials assessing prehospital administration of ketamine in analgesic doses compared with other analgesic drugs or no analgesic treatment in adults. We searched PubMed, EMBASE, Cochrane Library and Epistemonikos from inception until 15 February 2020, including relevant articles in English and Nordic languages. We used the Cochrane and Grading of Recommendations Assessment, Development and Evaluation methodologies and exclusively assessed patient-centred outcomes. Two independent authors screened trials for eligibility, extracted data and assessed risk of bias.Results We included eight studies (2760 patients). Ketamine was compared with various opioids given alone, and intranasal ketamine given with nitrous oxide was compared with nitrous oxide given alone. Four randomised controlled trials (RCTs) and one cluster randomised trial included 699 patients. One prospective cohort included 27 patients and two retrospective cohorts included 2034 patients. Five of the eight studies had high risks of bias. Pain score with ketamine is probably lower than after opioids as demonstrated in a cluster-RCT (308 patients) and a retrospective cohort (158 patients) study, Δvisual analogue scale −0.4 (−0.8 to 0.0) and Δnumeric pain rating scale −3.0 (−3.86 to −2.14), respectively. Ketamine probably leads to less nausea and vomiting (risk ratio (RR) 0.24 (0.11 to 0.52)) but more agitation (RR 7.81 (1.85 to 33)) than opioids.Conclusions This systematic literature review finds that ketamine probably reduces pain more than opioids and with less nausea and vomiting but higher risk of agitation. Risk of bias in included studies is high.Other Scandinavian society of anaesthesiology and intensive care medicine funded meetings and software. The Norwegian Air Ambulance Foundation funded publication. Otherwise this research received no grant from any agency in the public, commercial or not-for-profit sectors.PROSPERO registration number CRD42018114399. |
| format | Article |
| id | doaj-art-3a5cc7ccb19e4cfa93f747bfc0c89489 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-11-01 |
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| spelling | doaj-art-3a5cc7ccb19e4cfa93f747bfc0c894892025-08-20T02:28:27ZengBMJ Publishing GroupBMJ Open2044-60552020-11-01101110.1136/bmjopen-2020-038134Ketamine for the treatment of prehospital acute pain: a systematic review of benefit and harmLeif Rognås0Lasse Raatiniemi1Mårten Sandberg2Per Kristian Hyldmo3Poul Kongstad4Kristian Dahl Friesgaard5Robert Larsen6Vidar Magnusson7Jouni Kurola8Marius Rehn9Gunn Elisabeth Vist10Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark1 Research group of anesthesiology, Medical Research Centre, University of Oulu, Oulu, FinlandDivision of Prehospital Services, Air Ambulance Department, Oslo University Hospital, Oslo, NorwayTrauma Unit, Sørlandet Hospital, Kristiansand, NorwayDepartment of Prehospital Care and Disaster Medicine, Region of Skåne, Lund, SwedenResearch Department, Prehospital Emergency Medical Service, Central Denmark Region, Aarhus, DenmarkDepartment of Anaesthesiology and Intensive Care, Linköping University Hospital, Linköping, SwedenLandspitalinn University Hospital, Reykjavik, IcelandCentre for Prehospital Emergency Medicine, Kuopio University Hospital, Kuopio, FinlandNorwegian Air Ambulance Foundation, Oslo, NorwayDivision for Health Services, Norwegian Institute of Public Health, Oslo, NorwayBackground Few publications have addressed prehospital use of ketamine in analgesic doses. We aimed to assess the effect and safety profile of ketamine compared with other analgesic drugs (or no drug) in adult prehospital patients with acute pain.Methods A systematic review of clinical trials assessing prehospital administration of ketamine in analgesic doses compared with other analgesic drugs or no analgesic treatment in adults. We searched PubMed, EMBASE, Cochrane Library and Epistemonikos from inception until 15 February 2020, including relevant articles in English and Nordic languages. We used the Cochrane and Grading of Recommendations Assessment, Development and Evaluation methodologies and exclusively assessed patient-centred outcomes. Two independent authors screened trials for eligibility, extracted data and assessed risk of bias.Results We included eight studies (2760 patients). Ketamine was compared with various opioids given alone, and intranasal ketamine given with nitrous oxide was compared with nitrous oxide given alone. Four randomised controlled trials (RCTs) and one cluster randomised trial included 699 patients. One prospective cohort included 27 patients and two retrospective cohorts included 2034 patients. Five of the eight studies had high risks of bias. Pain score with ketamine is probably lower than after opioids as demonstrated in a cluster-RCT (308 patients) and a retrospective cohort (158 patients) study, Δvisual analogue scale −0.4 (−0.8 to 0.0) and Δnumeric pain rating scale −3.0 (−3.86 to −2.14), respectively. Ketamine probably leads to less nausea and vomiting (risk ratio (RR) 0.24 (0.11 to 0.52)) but more agitation (RR 7.81 (1.85 to 33)) than opioids.Conclusions This systematic literature review finds that ketamine probably reduces pain more than opioids and with less nausea and vomiting but higher risk of agitation. Risk of bias in included studies is high.Other Scandinavian society of anaesthesiology and intensive care medicine funded meetings and software. The Norwegian Air Ambulance Foundation funded publication. Otherwise this research received no grant from any agency in the public, commercial or not-for-profit sectors.PROSPERO registration number CRD42018114399.https://bmjopen.bmj.com/content/10/11/e038134.full |
| spellingShingle | Leif Rognås Lasse Raatiniemi Mårten Sandberg Per Kristian Hyldmo Poul Kongstad Kristian Dahl Friesgaard Robert Larsen Vidar Magnusson Jouni Kurola Marius Rehn Gunn Elisabeth Vist Ketamine for the treatment of prehospital acute pain: a systematic review of benefit and harm BMJ Open |
| title | Ketamine for the treatment of prehospital acute pain: a systematic review of benefit and harm |
| title_full | Ketamine for the treatment of prehospital acute pain: a systematic review of benefit and harm |
| title_fullStr | Ketamine for the treatment of prehospital acute pain: a systematic review of benefit and harm |
| title_full_unstemmed | Ketamine for the treatment of prehospital acute pain: a systematic review of benefit and harm |
| title_short | Ketamine for the treatment of prehospital acute pain: a systematic review of benefit and harm |
| title_sort | ketamine for the treatment of prehospital acute pain a systematic review of benefit and harm |
| url | https://bmjopen.bmj.com/content/10/11/e038134.full |
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