Out-of-Hospital Intranasal Ketamine as an Adjunct to Fentanyl for the Treatment of Acute Traumatic Pain: A Randomized Clinical Trial

Methodology: 4/5
Usefulness: 2/5

McMullan JT, et al. Ann Emerg Med. 2024 Oct;84(4):363-373. doi: 10.1016/j.annemergmed.2024.04.018.

Question and Methods: This out of hospital, placebo-controlled, blinded, parallel group RCT compared reduction in pain scores between Fentanyl + IN Placebo and Fentanyl with IN Ketamine.
Findings: There was no significant difference in reduction of pain scores or adverse events between the control and experimental group from 30 mins to 3 hours after treatment.
Limitations: The external validity is limited with exclusion of females, non-English speaking patients, the type of trauma that patients suffered, and differences in EMS medical directives between Ontario and Cincinnati.

Interpretation: We should continue to treat trauma patients with multi-modal analgesia, however, IN Ketamine is shown to be a safe adjunct and can be considered in populations with contraindications to usual analgesia.

Dr. Tayler Young

JC Supervisor: Dr. Venkatesh Thiruganasambandamoorthy

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Authors

Tayler Young

Tayler Young finishing her 4th year of medical school at the University of Ottawa, and starting her residency at the University of Queens.
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Hans Rosenberg

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

Dr. Venkatesh Thiruganasambandamoorthy is an attending physician and associate scientist at the Ottawa Hospital and Ottawa Hospital Research Institute with an particular interest in syncope and presyncope care.
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