Akhil Bansal1, Matthew Miller2,3,4, Ian Ferguson2,5,6, Brian Burns1,2,7. 1. Sydney Medical School, University of Sydney, Camperdown, NSW, Australia. 2. GSA-HEMS, NSW Ambulance, Bankstown Aeromedical Base, Bankstown, NSW, Australia. 3. Department of Anesthesia, St George Hospital, Kogarah, NSW, Australia. 4. University of New South Wales, St George and Sutherland Clinical Schools, Sydney, NSW, Australia. 5. South Western Clinical School, University of New South Wales, Liverpool, NSW, Australia. 6. South West Sydney Emergency Research Institute, South West Sydney Local Health District, NSW, Australia. 7. Northern Beaches Hospital, French's Forest, NSW, Australia.
Abstract
OBJECTIVE: Analgesia in the prehospital setting is an extremely important, yet controversial topic. Ketamine, a N-methyl D-aspartate (NMDA) receptor antagonist, has been commonly used in the prehospital setting, including recommendations by the US Department of Defense and by the Royal Australian College of Pain Medicine, despite the paucity of high-level evidence. METHODS: Accordingly, a review of the literature was conducted using several electronic medical literature databases from the earliest available records to the time at which the search was conducted (October 2018). RESULTS: The search strategy yielded a total of 707 unique papers, of which 43 were short-listed for full review, and ultimately, ten papers were identified as meeting all the relevant inclusion criteria. The included studies varied significantly in the prehospital context and in the means of administering ketamine. There was only low-grade evidence that ketamine offered a safe and effective analgesia when used as the only analgesic, and only low-grade evidence that it was as effective as alternative opioid options. However, there was moderate evidence that co-administration of ketamine with morphine may improve analgesic efficacy and reduce morphine requirement. CONCLUSIONS: Overall, ketamine as a prehospital analgesic may be best used in combination with opioids to reduce opioid requirement. It is suggested that future studies should use a standardized approach to measuring pain reduction. Future studies should also investigate short-term side effects and long-term complications or benefits of prehospital ketamine.
OBJECTIVE:Analgesia in the prehospital setting is an extremely important, yet controversial topic. Ketamine, a N-methyl D-aspartate (NMDA) receptor antagonist, has been commonly used in the prehospital setting, including recommendations by the US Department of Defense and by the Royal Australian College of Pain Medicine, despite the paucity of high-level evidence. METHODS: Accordingly, a review of the literature was conducted using several electronic medical literature databases from the earliest available records to the time at which the search was conducted (October 2018). RESULTS: The search strategy yielded a total of 707 unique papers, of which 43 were short-listed for full review, and ultimately, ten papers were identified as meeting all the relevant inclusion criteria. The included studies varied significantly in the prehospital context and in the means of administering ketamine. There was only low-grade evidence that ketamine offered a safe and effective analgesia when used as the only analgesic, and only low-grade evidence that it was as effective as alternative opioid options. However, there was moderate evidence that co-administration of ketamine with morphine may improve analgesic efficacy and reduce morphine requirement. CONCLUSIONS: Overall, ketamine as a prehospital analgesic may be best used in combination with opioids to reduce opioid requirement. It is suggested that future studies should use a standardized approach to measuring pain reduction. Future studies should also investigate short-term side effects and long-term complications or benefits of prehospital ketamine.
Authors: Christopher Rugg; Simon Woyke; Wolfgang Voelckel; Peter Paal; Mathias Ströhle Journal: Scand J Trauma Resusc Emerg Med Date: 2021-02-01 Impact factor: 2.953
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