A randomized, noninferiority, controlled trial of two doses of intravenous subdissociative ketamine for analgesia in the emergency department
Autor: | Erica Koch, Megan A. Rech, Robert Riggs, Trent Reed, Ramon A. Durazo-Arvizu, George Lew, Shannon Lovett |
---|---|
Rok vydání: | 2021 |
Předmět: |
Adult
Moderate to severe Adolescent law.invention Young Adult 03 medical and health sciences 0302 clinical medicine Double-Blind Method Randomized controlled trial law Clinical endpoint Humans Medicine Ketamine Prospective Studies Adverse effect Pain Measurement Pain score business.industry 030208 emergency & critical care medicine General Medicine Emergency department Middle Aged Acute Pain Confidence interval Analgesics Opioid Treatment Outcome Anesthesia Emergency Medicine Analgesia Emergency Service Hospital business medicine.drug |
Zdroj: | Academic Emergency Medicine. |
ISSN: | 1553-2712 1069-6563 |
DOI: | 10.1111/acem.14200 |
Popis: | Objective This study aimed to determine if 0.15 mg/kg intravenous (IV) subdissociative ketamine is noninferior to 0.3 mg/kg in emergency department (ED) patients with acute pain. Methods This randomized, prospective, double-blinded, noninferiority trial included patients' age 18 to 59 years presenting to the ED with acute moderate to severe pain. Subjects were randomized to IV subdissociative ketamine, 0.15 mg/kg ("low" dose) or 0.30 mg/kg ("high" dose), over 15 minutes. The primary endpoint was the 11-point numeric rating scale (NRS) pain score between groups at 30 minutes. Secondary endpoints included NRS pain scores at 15 and 60 minutes; change in NRS at 15, 30, and 60 minutes; rescue analgesia; and adverse effects. The noninferiority limit, δ0 , was set to 1.3. Results Forty-nine patients were included in each group. After the differences in the baseline NRS score were adjusted for, the mean NRS score at 30 minutes was 4.7 (95% confidence interval [CI] = 3.8 to 5.5) in the low-dose group and 5.0 (95% CI = 4.2 to 5.8) in the high-dose group (mean difference = 0.4, 95% CI = -0.8 to 1.5), indicating that the low-dose subdissociative ketamine was noninferior to the high dose (lower limit of 95% CI = -0.8 to ≥1.3 = -δ0 ). Adverse effects were similar at 30 minutes. At 15 minutes, the high-dose group experienced greater change in NRS; however, more adverse effects occurred. Conclusion Our data did not detect a large difference in analgesia or adverse effect profile between 0.15 mg/kg IV ketamine and 0.30 mg/kg in the short-term treatment of acute pain in the ED. |
Databáze: | OpenAIRE |
Externí odkaz: |
Pro tento záznam nejsou dostupné žádné jednotky.