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Ketamine as a Prehospital Analgesic: A Systematic Review

Published online by Cambridge University Press:  15 April 2020

Akhil Bansal Open the ORCID record for Akhil Bansal [Opens in a new window] ,
Matthew Miller ,
Ian Ferguson  and
Brian Burns
Akhil Bansal*
Affiliation:
Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
Matthew Miller
Affiliation:
GSA-HEMS, NSW Ambulance, Bankstown Aeromedical Base, Bankstown, NSW, Australia Department of Anesthesia, St George Hospital, Kogarah, NSW, Australia University of New South Wales, St George and Sutherland Clinical Schools, Sydney, NSW, Australia
Ian Ferguson
Affiliation:
GSA-HEMS, NSW Ambulance, Bankstown Aeromedical Base, Bankstown, NSW, Australia South Western Clinical School, University of New South Wales, Liverpool, NSW, Australia South West Sydney Emergency Research Institute, South West Sydney Local Health District, NSW, Australia
Brian Burns
Affiliation:
Sydney Medical School, University of Sydney, Camperdown, NSW, Australia GSA-HEMS, NSW Ambulance, Bankstown Aeromedical Base, Bankstown, NSW, Australia Northern Beaches Hospital, French’s Forest, NSW, Australia
*
Correspondence: Akhil Bansal, BSc (Adv) 8A Heydon Av WarraweeNSW2074, Australia, Email: [email protected]
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Abstract

Objective:

Analgesia in the prehospital setting is an extremely important, yet controversial topic. Ketamine, a N-methyl D-aspartate (NMDA) receptor antagonist, has been commonly used in the prehospital setting, including recommendations by the US Department of Defense and by the Royal Australian College of Pain Medicine, despite the paucity of high-level evidence.

Methods:

Accordingly, a review of the literature was conducted using several electronic medical literature databases from the earliest available records to the time at which the search was conducted (October 2018).

Results:

The search strategy yielded a total of 707 unique papers, of which 43 were short-listed for full review, and ultimately, ten papers were identified as meeting all the relevant inclusion criteria. The included studies varied significantly in the prehospital context and in the means of administering ketamine. There was only low-grade evidence that ketamine offered a safe and effective analgesia when used as the only analgesic, and only low-grade evidence that it was as effective as alternative opioid options. However, there was moderate evidence that co-administration of ketamine with morphine may improve analgesic efficacy and reduce morphine requirement.

Conclusions:

Overall, ketamine as a prehospital analgesic may be best used in combination with opioids to reduce opioid requirement. It is suggested that future studies should use a standardized approach to measuring pain reduction. Future studies should also investigate short-term side effects and long-term complications or benefits of prehospital ketamine.

Keywords

analgesiaketamineprehospital
Type
Systematic Review
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 3 , June 2020 , pp. 314 - 321
Copyright
© World Association for Disaster and Emergency Medicine 2020

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