The study aimed to offer description on the use, as well as the effect resulting from low-dose ketamine or LDK for the analgesia cases in the emergency department (ED). The study used a retrospective mode of data collection where information on patients who received LDK for analgesia were used to describe the effectiveness and safety of the drug. The study used those patients who were aged 18 years and above and were given ketamine in the ED within a period of two years when the study was conducted. Parameters such as dose, route used to administer the drug, as well as the effect of LDK were collected (Lester, Braude, Niles, & Crandall, 2010).
The site of the study was an urban level 1 trauma center and a local county hospital, which also acts as the university teaching hospital. The subjects used in the study were those patients visited the hospital, were 18 years old or above and received ketamine in two years set for the study. A review of the electronic medical record was done with the aim of identifying the patients who were given LDK as an analgesia.
The records were also used to determine the dose given, route of administration, as well as the effect caused by LDK administration. In addition, use of pain medications such as narcotics before and/or after administration of LDK was also recorded. Demographic data such as age, sex, use of illicit drugs, pain medication, or alcohol, medical history and discharge time were also assessed. The obtained data was analyzed and presented in a descriptive manner.
Cases where LDK was administered totaled to 35 cases representing 34 different types of patients. On average, the patients had an age of 37 years, with 66% of them being men and 34% female. Abscess was the main complaint which accounted for 46% of all the cases recorded. In all cases, 80% of the patients reported having used chronic medication or abuse of illicit drugs. The ketamine dose ranged from as low as 5 mg to as high as 35 mg while the mean dose was reported to be 15.7 mg. Out of the 35 cases, 12 (34%) cases reported a repeated dosing and the maximum dose totaled to 60 mg, which was administered three times each at a dose of 20-mg intramuscular doses. Administration of the drug occurred mainly through intravenous (86%) and in few cases through intramuscular injection (14%). Administration of opioids was done either before LDK or concurrently in most cases (91%).
Administration of low doses of ketamine was reported to improve pain in almost half of the cases (54%) while in 23 % of the cases there were no benefits that were reported. Eight of the cases had no report on the pain scale after drug administration. For the patients who had improved pain score after the administration of LDK, there were only three from a total 19 who were given additional opioid medications. For the group that did not show improvement, 5 of them were given an additional pain.
The results obtained from the study suggested effectiveness of LDK as an adjunct to pain medication using opioid especially in patients who have pain that is hard to treat. Some of the patients in the case study include those who had high narcotics tolerance. The administration of LDK gave a clinical significance in the reduction of pain in half of the cases suggesting that LDK may have effective when used as an analgesic in ED. The fact that some of the patients were discharged without getting more parenteral narcotics is an indicator that LDK was effective in about 63% of the cases.
The results also offer a suggestion that there is the possibility of opioid having a sparing effect in those patients who respond to LDK treatment. There were no dangerous adverse cases that were reported after LDK was administered other than one minor adverse effect. During administration, the study reports that it is important to instruct nurses to administer the medication slowly for a period of one minute as well as warn the patient about chances of having unpleasant rush. The study has thus provided some evidence on the use of LDK as an analgesic in ED. It also suggests that its use may be safe and effective in a number of cases especially where patients suffer from high narcotic tolerance.
Although the study offers crucial information on the efficacy of LDK as an adjunct to the treatment of pain, it suffers from a number of limitation that may prevent such results to be used a general population. One of the limitations, which the author also admits, is the fact that the study was just a retrospective study. It was thus not possible to do randomization to the results, or add placebo control to compare with the treated samples. The other limitation is on the small sample size, which could not offer enough information that would result in a concrete conclusion. It is thus important to conduct a study that will address these limitations.
References List
Lester, L., Braude, D. A., Niles, C., & Crandall, C. S. (2010). Low-dose ketamine for analgesia in the ED: a retrospective case series. The American journal of emergency medicine, 28(7), 820-827.
