Ahern Terence L, Herring Andrew A, Miller Steve, Frazee Bradley W
Departments of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland.
Emergency Medicine, University of California, San Francisco, California, USA.
Pain Med. 2015 Jul;16(7):1402-9. doi: 10.1111/pme.12705. Epub 2015 Feb 3.
Use of low-dose ketamine infusions in the emergency department (ED) has not previously been described, despite routine use in perioperative and other settings. Our hypothesis was that a low-dose ketamine bolus followed by continuous infusion would 1) provide clinically significant and sustained pain relief; 2) be well tolerated; and 3) be feasible in the ED.
We prospectively administered 15 mg intravenous ketamine followed immediately by continuous ketamine infusion at 20 mg/h for 1 hour. Optional morphine (4 mg) was offered at 20, 40, and 60 minutes. Pain intensity, vitals signs, level of sedation, and adverse reactions were assessed for 120 minutes.
A total of 38 patients were included with a median initial numerical rating scale (NRS) pain score of 9. At 10 minutes, the median reduction in pain score was 4, with 7 patients reporting a score of 0. At 60 and 120 minutes, 25 and 26 patients, respectively, reported clinically significant pain reduction (decrease NRS score > 3). Heart rate, blood pressure, respiratory rate, and oxygen saturation remained stable. Mild or moderate side effects including dizziness, fatigue, and headache were common. Patient satisfaction was high; 85% reported they would have this medication again for similar pain.
A low-dose ketamine infusion protocol provided significant pain relief with mostly mild side effects and no severe adverse events.
尽管氯胺酮在围手术期和其他场景中常规使用，但此前尚未有在急诊科（ED）使用低剂量氯胺酮输注的相关描述。我们的假设是，先给予低剂量氯胺酮推注，随后持续输注，将能够：1）提供具有临床意义且持续的疼痛缓解；2）耐受性良好；3）在急诊科可行。
我们前瞻性地给予15毫克静脉注射氯胺酮，随后立即以20毫克/小时的速度持续输注氯胺酮1小时。在20、40和60分钟时可选择给予吗啡（4毫克）。对疼痛强度、生命体征、镇静水平和不良反应进行120分钟的评估。
共纳入38例患者，初始数字评分量表（NRS）疼痛评分中位数为9分。10分钟时，疼痛评分中位数降低4分，7例患者报告评分为0分。在60分钟和120分钟时，分别有25例和26例患者报告疼痛有临床显著减轻（NRS评分降低>3分）。心率、血压、呼吸频率和血氧饱和度保持稳定。常见轻度或中度副作用，包括头晕、疲劳和头痛。患者满意度较高；85%的患者报告若再次因类似疼痛愿意接受这种药物治疗。
低剂量氯胺酮输注方案能显著缓解疼痛，大多为轻度副作用，且无严重不良事件。
