Ketamine May Be an Effective Alternative to Opioids

Low-dose ketamine (LDK) is as effective as opioids for the control of acute pain in the in the emergency department (ED), and could serve as an analgesic alternative.

The systematic review and meta-analysis of randomized controlled trials, conducted by researchers at Washington University School of Medicine (WUSTL; St. Louis, MO, USA), and Maimonides Medical Center (New York, NY, USA), compared intravenous (IV) opioids to LDK for relief of acute pain in the ED setting. Studies in which the control group initially received opioids prior to LDK were excluded. Search strategy was comprised of changes in visual analog scale (VAS) or numeric rating scale pain scales.

In all, three studies met the criteria for inclusion in the meta-analysis. Results showed that compared to pain scale reduction with morphine, LDK was not inferior. No severe adverse events with ketamine were reported in any study, but higher rates of non-severe adverse events were shown. In addition, the emergence delirium or dissociation usually associated with larger doses of ketamine were not apparent with LDK. Another potential complication, laryngospasm, was also rare. The study was published on July 17, 2018, in Academic Emergency Medicine.

“Opioids are commonly prescribed for the treatment of acute pain, but due to the epidemic of opioid misuse, analgesic alternatives are being explored. Ketamine appears to be a legitimate and safe alternative to opioids for treating acute pain in the ED,” concluded senior author Evan Schwarz, MD, of WUSTL. “Although adverse events associated with ketamine were reported, few appeared to be clinically significant. Emergency physicians can feel comfortable using it instead of opioids.”

Ketamine is commonly used as a rapidly acting, dissociative anesthetic agent that can provide analgesia, sedation, and amnesia for rapid sequence intubation in critically ill patients. Short- and long-term effects include increased heart rate and blood pressure, nausea, vomiting, numbness, depression, amnesia, hallucinations, and potentially fatal respiratory problems. Sub-anesthetic ketamine is often administered intraoperatively for postoperative analgesia due to the detached, dreamlike state it creates.

Related Links:
Washington University School of Medicine
Maimonides Medical Center