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Ketamine for the treatment of prehospital acute pain : a systematic review of benefit and harm |
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| Author: | Sandberg, Mårten1,2; Hyldmo, Per Kristian3,4,5; Kongstad, Poul6; |
| Organizations: |
1Division of Prehospital Services, Air Ambulance Department, Oslo University Hospital, Oslo, Norway 2Faculty of Medicine, University of Oslo, Oslo, Norway 3Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
4Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
5Trauma Unit, Sørlandet Hospital, Kristiansand, Norway 6Department of Prehospital Care and Disaster Medicine, Region of Skåne, Lund, Sweden 7Research Department, Prehospital Emergency Medical Service, Central Denmark Region, Aarhus, Denmark 8Department of Anaesthesiology, Regional Hospital of Horsens, Horsens, Denmark 9Centre for Prehospital Emergency Care, Oulu University Hospital, Oulu, Finland 10Anaesthesia Research group, MRC, Oulu University Hospital and University of Oulu, Oulu, Finland 11Department of Anaesthesiology and Intensive Care, Linköping University Hospital, Linköping, Sweden 12Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden 13Landspitalinn University Hospital, Reykjavik, Iceland 14Danish Air Ambulance, Aarhus, Denmark 15Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark 16Department of Clinical Medicine, Aarhus University, Aarhus, Denmark 17Centre for Prehospital Emergency Medicine, Kuopio University Hospital, Kuopio, Finland 18University of Eastern Finland, Kuopio, Finland 19Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway |
| Format: | article |
| Version: | published version |
| Access: | open |
| Online Access: | PDF Full Text (PDF, 1.2 MB) |
| Persistent link: | http://urn.fi/urn:nbn:fi-fe202102033631 |
| Language: | English |
| Published: |
BMJ,
2020
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| Publish Date: | 2021-02-03 |
| Description: |
AbstractBackground: 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. see all
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| Series: |
BMJ open |
| ISSN: | 2044-6055 |
| ISSN-E: | 2044-6055 |
| ISSN-L: | 2044-6055 |
| Volume: | 10 |
| Issue: | 11 |
| Article number: | e038134 |
| DOI: | 10.1136/bmjopen-2020-038134 |
| OADOI: | https://oadoi.org/10.1136/bmjopen-2020-038134 |
| Type of Publication: |
A1 Journal article – refereed |
| Field of Science: |
3126 Surgery, anesthesiology, intensive care, radiology |
| Subjects: | |
| Funding: |
SSAI funded meetings and software costs. The Norwegian Air Ambulance Foundation funded publication costs. Otherwise this research received no further grant from any funding agency in the public, commercial or not-for-profit sectors. |
| Copyright information: |
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/. |
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https://creativecommons.org/licenses/by-nc/4.0/ |