Methodology: 2/5
Usefulness: 2.5 /5

Lumanauw DD, et al. Acad Emerg Med. 2019 Sep;26(9):1044-1051. doi: 10.1111/acem.13755. Epub 2019 Apr 29.

Question and Methods: A randomized placebo-controlled trial to determine if sub-dissociative dose Ketamine (SDDK) is effective for treating acute exacerbations of chronic Pain in the emergency department.

Findings: Ketamine infusions at both 0.5 and 0.25 mg/kg over 20 minutes were effective in treating acute exacerbations of chronic pain in the Emergency Department with no difference between these two groups (NNT of 2.34 and 2.54). Ketamine infusion did not demonstrate long-term pain control in the next 24-48 hours, required a significant amount of rescue medications and was associated with more side effects.

Major Limitations: Single-center study with a small sample size, using a modified ITT analysis.

Interpretation: A larger and better-designed study is required to support the use of ketamine to treat acute on chronic pain in the Emergency Department.

By: Dr. Olivier Levac-Martinho  

Hans Rosenberg
Dr. Rosenberg is an emergency physician at the Ottawa Hospital, assistant professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.