Department of Emergency Medicine, University of New Mexico, Albuquerque, NM 87131-0001, USA.
Am J Emerg Med. 2010 Sep;28(7):820-7. doi: 10.1016/j.ajem.2009.07.023. Epub 2010 Apr 2.
The aim of this study was to describe the use and effect of low-dose ketamine (LDK) for analgesia in the emergency department (ED).
A chart review was performed to identify all adult patients who received LDK for analgesia in our ED. Cases were identified by pharmacy record of ketamine administration. Low-dose ketamine was defined as the administration of 0.1 to 0.6 mg/kg of ketamine for pain control. Use of ketamine during procedural sedation was excluded. Data were analyzed descriptively.
Thirty-five cases in which patients received LDK in the ED for a 2-year period were identified. Doses ranged from 5 to 35 mg. Administration was intravenous in 30 (86%) of 35 cases and intramuscular in 5 (14%) of 35 cases. Opioids were administered before or coadministered with LDK in 32 (91%) of 35 cases, and in the remaining 3 cases, opioids were used before the patient came to the ED. Improvement in pain was observed in 19 (54%) of 35 cases in which patients received LDK. Pain scores did not improve in 8 (23%) of 35 cases. Insufficient data were available to determine LDK effect for 8 (23%) of 35 cases. No significant adverse events were identified in any of the 35 cases.
The administration of LDK in the ED may be a safe and effective adjunct for analgesia in some patients. However, prospective randomized controlled trials are needed before widespread use of LDK for analgesia in the ED can be recommended.
本研究旨在描述低剂量氯胺酮（LDK）在急诊科（ED）用于镇痛的使用情况和效果。
通过病历回顾，确定了所有在我院 ED 接受 LDK 镇痛的成年患者。通过药剂科氯胺酮使用记录识别病例。将 0.1 至 0.6mg/kg 剂量的氯胺酮用于疼痛控制定义为 LDK。排除在程序镇静期间使用氯胺酮的情况。数据采用描述性分析。
在 2 年期间，共确定了 35 例在 ED 使用 LDK 的患者。剂量范围为 5 至 35mg。35 例中的 30 例（86%）为静脉内给药，5 例（14%）为肌肉内给药。35 例中的 32 例（91%）在给予 LDK 之前或同时给予了阿片类药物，在其余 3 例中，阿片类药物在患者到达 ED 之前使用。在接受 LDK 的 35 例患者中，有 19 例（54%）的疼痛得到改善。35 例中的 8 例（23%）疼痛评分没有改善。8 例（23%）的 LDK 效果数据不足，无法确定。在这 35 例中，没有发现任何明显的不良事件。
在 ED 中给予 LDK 可能是某些患者安全有效的辅助镇痛方法。然而，在推荐广泛将 LDK 用于 ED 镇痛之前，需要进行前瞻性随机对照试验。
