Comparison of Nebulized Ketamine at Three Different Dosing Regimens for Treating Painful Conditions in the Emergency Department: A Prospective, Randomized, Double-Blind Clinical Trial

Daniel Dove MD , Catsim Fassassi DO , Ashley Davis MD , Jefferson Drapkin MPH , Mahlaqa Butt MPH , Rukhsana Hossain MPH , Sarah Kabariti MPH , Antonios Likourezos MA, MPH

Ankit Gohel PharmD , Patrizia Favale PharmD , Michael Silver MS , John Marshall MD  and Sergey Motov MD

Annals of Emergency Medicine, 2021-12-01, Volume 78, Issue 6, Pages 779-787, Copyright © 2021 American College of Emergency Physicians

Study objective

We aimed to assess and compare the analgesic efficacies and adverse effects of ketamine administered through a breath-actuated nebulizer at 3 different dosing regimens for emergency department patients presenting with acute and chronic painful conditions.

Methods

This was a prospective, randomized, double-blinded trial comparing 3 doses of nebulized ketamine (0.75 mg/kg, 1 mg/kg, and 1.5 mg/kg) administered through breath-actuated nebulizer in adult emergency department patients aged 18 years and older with moderate to severe acute and chronic pain. The primary outcome included the difference in pain scores on an 11-point numeric rating scale between all 3 groups at 30 minutes. Secondary outcomes included the need for rescue analgesia (additional doses of nebulized ketamine or intravenous morphine) and adverse events in each group at 30 and 60 minutes.

Results

We enrolled 120 subjects (40 per group). The difference in mean pain scores at 30 minutes between the 0.75 mg/kg and 1 mg/kg groups was 0.25 (95% confidence interval [CI] 1.28 to 1.78); between the 1 mg/kg and 1.5 mg/kg groups was −0.225 (95% CI −1.76 to 1.31); and between the 0.75 mg/kg and 1.5 mg/kg groups was 0.025 (95% CI −1.51 to 1.56). No clinically concerning changes in vital signs occurred. No serious adverse events occurred in any of the groups.

Conclusion

We found no difference between all 3 doses of ketamine administered through breath-actuated nebulizer for short-term treatment of moderate to severe pain in the emergency department.

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