Southern Health Emergency Medicine Research Group, Southern Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia.
Emerg Med Australas. 2013 Apr;25(2):161-7. doi: 10.1111/1742-6723.12059. Epub 2013 Mar 20.
The present study aims to conduct a pilot study examining the effectiveness of intranasal (IN) ketamine as an analgesic for children in the ED.
The present study used an observational study on a convenience sample of paediatric ED patients aged 3-13 years, with moderate to severe (≥6/10) pain from isolated limb injury. IN ketamine was administered at enrolment, with a supplementary dose after 15 min, if required. Primary outcome was change in median pain rating at 30 min. Secondary outcomes included change in median pain rating at 60 min, patient/parent satisfaction, need for additional analgesia and adverse events being reported.
For the 28 children included in the primary analysis, median age was 9 years (interquartile range [IQR] 6-10). Twenty-three (82.1%) were male. Eighteen (64%) received only one dose of IN ketamine (mean dose 0.84 mg/kg), whereas 10 (36%) required a second dose at 15 min (mean for second dose 0.54 mg/kg). The total mean dose for all patients was 1.0 mg/kg (95% CI: 0.92-1.14). The median pain rating decreased from 74.5 mm (IQR 60-85) to 30 mm (IQR 12-51.5) at 30 min (P < 0.001, Mann-Whitney). For the 24 children who contributed data at 60 min, the median pain rating was 25 mm (IQR 4-44). Twenty (83%) subjects were satisfied with their analgesia. Eight (33%) were given additional opioid analgesia and the 28 reported adverse events were all transient and mild.
In this population, an average dose of 1.0 mg/kg IN ketamine provided adequate analgesia by 30 min for most patients.
本研究旨在进行一项试点研究，以检验鼻内（IN）氯胺酮作为急诊科儿童镇痛剂的效果。
本研究采用便利抽样法对 3-13 岁的孤立性肢体损伤儿童进行观察性研究，这些儿童的疼痛为中度至重度（≥6/10）。在入组时给予 IN 氯胺酮，15 分钟后如果需要则给予补充剂量。主要结局为 30 分钟时中位数疼痛评分的变化。次要结局包括 60 分钟时中位数疼痛评分的变化、患者/家长满意度、需要额外镇痛以及报告的不良事件。
在主要分析中，28 名儿童纳入研究，中位年龄为 9 岁（四分位距 [IQR] 6-10）。23 名（82.1%）为男性。18 名（64%）仅接受了一次 IN 氯胺酮剂量（平均剂量 0.84mg/kg），而 10 名（36%）在 15 分钟时需要第二次剂量（第二次剂量的平均剂量为 0.54mg/kg）。所有患者的总平均剂量为 1.0mg/kg（95%CI：0.92-1.14）。疼痛评分中位数从 74.5mm（IQR 60-85）下降到 30mm（IQR 12-51.5）（P<0.001，Mann-Whitney）。在 60 分钟时提供数据的 24 名儿童中，疼痛评分中位数为 25mm（IQR 4-44）。20 名（83%）患者对镇痛效果满意。8 名（33%）给予了额外的阿片类镇痛药，28 名报告了不良事件均为短暂和轻度的。
在本研究人群中，平均剂量为 1.0mg/kg 的 IN 氯胺酮在 30 分钟内为大多数患者提供了足够的镇痛效果。
