Intranasal Ketamine as an Adjunct to Fentanyl for the Prehospital Treatment of Acute Traumatic Pain
Abstract
Parenteral opiates, including fentanyl, are the mainstay of prehospital treatment of pain after traumatic injuries, but many experience suboptimal pain control. Ketamine is increasingly used/may offer opiate-sparing effects, but fentanyl w/ketamine is inadequately studied. We hypothesized adding intranasal ketamine (IK) to standard of care (SOC) fentanyl, compared to fentanyl alone, improves early pain control. Methods: A single center, placebo controlled, blinded, randomized clinical trial was conducted. Men 18-65 requiring SOC fentanyl to treat pain prehospital were screened/consented. Randomized to receive 50 milligrams (mg) IK or placebo, fentanyl route. The primary outcome was proportion of subjects experiencing two-point reduction in self-described pain on 11-point Verbal Numerical Rating Scale post IK/placebo administration. Results: 192, aged 36 [27-51] (median [IQR]) years old, rating pain of 10 [IQR 9-10] were enrolled. There was no difference in proportion experiencing improved pain thirty minutes after treatment (32/89 receiving fentanyl and placebo and 46/103 receiving fentanyl and IK, p=0.22) or at any time through 180 minutes. There was no difference in the proportion requiring additional pain medications at any time or those experiencing side effects/adverse events. Conclusion: 50mg IK to SOC fentanyl prehospital did not improve early pain management or reduce additional pain medication need.
Document Details
- Document Type
- Technical Report
- Publication Date
- Oct 01, 2022
- Accession Number
- AD1185839
Entities
People
- Chris Droege
- Chris Lindsell
- Dario Rodriguez
- Jason Mcmullan
- Kathleen Chard
- Kim Hart
- Mel Otten
Organizations
- University of Cincinnati