Intravenous Low-Dose Ketamine Provides Greater Pain Control Compared to Fentanyl in a Civilian Prehospital Trauma System: A Propensity Matched Analysis

Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors
E Stein BronskyDavid Bar-Or

Abstract

Objective: A few studies report comparable analgesic efficacy between low-dose ketamine and opioids such as morphine or fentanyl; however, limited research has explored the safety and effectiveness of intravenous low-dose ketamine as a primary analgesic in a civilian prehospital setting. The objective of this study is to compare pain control between low-dose ketamine and fentanyl when administered intravenously (IV) for the indication of severe pain. Methods: This was a retrospective, observational review of prehospital adult patients (≥18 years) who presented with severe pain (numeric rating scale, 7-10) and were treated solely with either low-dose ketamine IV or fentanyl IV between January 1, 2014 and December 31, 2016. Propensity matched analysis was performed adjusting for all baseline variables with p ≤ 0.10 and for baseline pain score to match ketamine and fentanyl patients on a one-to-one ratio. The primary outcome was change in pain score from baseline to after treatment and evaluated with a paired t-test. Secondary outcomes were changes in vital signs and Glasgow coma scale (GCS) from baseline to after treatment, as well as incidence of clinically significant adverse events (AEs); AEs were followed from scene arrival t...Continue Reading

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Citations

Sep 4, 2019·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·Diana M SobierajWilliam L Baker
Sep 5, 2020·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·Emily J RobinsonLawrence H Brown
Jun 12, 2021·Annals of Emergency Medicine·Antonio R FernandezJ Brent Myers
Dec 6, 2021·Military Medicine·Grace E BebartaSteven G Schauer
Dec 2, 2021·American Journal of Physiology. Regulatory, Integrative and Comparative Physiology·Mu HuangCraig G Crandall

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