Infusion vs IV Push Ketamine for Pain

Spoon Feed
A slow infusion of ketamine for pain control was as effective as IV push, with less sedation and far fewer patients having a feeling of unreality.

Why does this matter?
Ketamine is highly effective for pain control and may be used as an adjunct to opioids, but it has the side effect of causing patients to feel detached from reality – which is not a good feeling.  Giving it by slow IV infusion controlled pain just as well but without that nasty side effect.

Special K infusion
This was a small but well done RCT of 48 patients presenting to the ED with painful conditions and pain score >5.  Ketamine 0.3mg/kg was given either by IV push (5 minutes) or slow infusion (given over 15 minutes).  Pain score was reduced the same in each group.  The infusion group had marked reduction in feeling of unreality and was less sedated compared to the IV push group.

Source
A prospective randomized, double-dummy trial comparing IV push low dose ketamine to short infusion of low dose ketamine for treatment of  pain in the ED.  Am J Emerg Med. 2017 Aug;35(8):1095-1100. doi: 10.1016/j.ajem.2017.03.004. Epub 2017 Mar 3.

Another Spoonful

• REBEL EM has a great post on this.
• Pharm ER Tox guy does too, from a pharmacist’s perspective.