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Nebulized vs IV Sub-dissociative Ketamine for Pain

June 27, 2024

Written by Ketan Patel

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Ketamine has been shown to be efficacious in managing acute pain conditions in the emergency department (ED), and this study showed equal efficacy between nebulized and intravenous administration of sub-dissociative ketamine (IV-SDK).

Versatility of ketamine for pain control
A prospective, randomized, double-blind, double-dummy trial of 150 adult patients, with pain rated at a score of ≥5 were administered IV-SDK (0.3 mg/kg) or nebulized ketamine (0.75 mg/kg). Pain scores 30 minutes post administration were measured as the primary outcome.

Results confirmed no significant difference in the reduction of pain between both arms at 30 minutes, with comparable clinically meaningful improvement in pain scores in both groups. No serious adverse reactions were noted in either group in the entire study period. Further analysis, however, showed that a notable population that received nebulized ketamine needed rescue analgesia.

Limitations of this study include a single-center design, possible sampling bias, and narrow time window of observed effect. Overall, the results suggest that both routes are effective for short-term pain management in the ED and are comparable.

Perhaps a larger, multi-center design with a longer observation period will further validate these approaches to pain control and better evaluate the long-term efficacy of each approach.

How will this change my practice?
Ketamine has amazing utility and versatility depending on the therapeutic effect intended. While in the ED, I’m not sure I’ll reach for nebulized ketamine first for acute pain, but it could be a great option in particular circumstances. A study in a pediatric population would be very helpful, especially avoiding needle sticks whenever possible. In the prehospital and even medicine realm, the nebulized option is very intriguing as well for the management of acute injuries.

Comparison of Nebulized Ketamine to Intravenous Subdissociative Dose Ketamine for Treating Acute Painful Conditions in the Emergency Department: A Prospective, Randomized, Double-Blind, Double-Dummy Controlled Trial. Ann Emerg Med. 2024 May 1:S0196-0644(24)00171-9. doi: 10.1016/j.annemergmed.2024.03.024. Epub ahead of print. PMID: 38703175.

What are your thoughts?