The Effects of Low-Dose Ketamine on Acute Pain in an Emergency Setting: A Systematic Review and Meta-Analysis

Eun Nam Lee, Jae Hoon Lee, Eun Nam Lee, Jae Hoon Lee

Abstract

Objectives: Currently ketamine is not used often as an analgesic in the emergency department (ED). Nonetheless, it can increase the efficiency of opioids and decrease their side effects. The purpose of this systematic review and meta-analysis was to evaluate whether low-dose ketamine in the ED provides better analgesia with fewer adverse effects.

Methods: The PubMed, EMBASE, and Cochrane Library databases were searched by two reviewers independently (last search performed on January 2016). Data were also extracted independently.

Results: A total of 6 trials involving 438 patients were included in the current analysis. Our subgroup analysis of pain reduction indicates that the favorable effects of ketamine were similar or superior to those of placebo or opioids, although these effects were heterogeneous. However, low-dose ketamine was associated with a higher risk of neurological (relative risk [RR] = 2.17, 95% confidence interval [CI] = 1.37-3.42, P < 0.001) and psychological events (RR = 13.86, 95% CI = 4.85-39.58, P < 0.001). In contrast, the opioid group had a higher risk of major cardiopulmonary events (RR = 0.22, 95% CI = 0.05-1.01, P = 0.05).

Conclusions: The efficiency of ketamine varies depending on the pain site, but low-dose ketamine may be a key agent for pain control in the ED, as it has no side effects. It may also help to reduce the side effects of opioids.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Study Selection PRISMA Flowchar.
Fig 1. Study Selection PRISMA Flowchar.
Fig 2. Risk of Bias Graph.
Fig 2. Risk of Bias Graph.
Fig 3. Risk of Bias Summary.
Fig 3. Risk of Bias Summary.
Fig 4. Subgroup Analysis of Pain Reduction.
Fig 4. Subgroup Analysis of Pain Reduction.
Fig 5. Meta-analysis of the Incidence of…
Fig 5. Meta-analysis of the Incidence of Adverse Events.

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