Motov Sergey, Mai Mo, Pushkar Illya, Likourezos Antonios, Drapkin Jefferson, Yasavolian Matthew, Brady Jason, Homel Peter, Fromm Christian
Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA.
Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA.
Am J Emerg Med. 2017 Aug;35(8):1095-1100. doi: 10.1016/j.ajem.2017.03.004. Epub 2017 Mar 3.
Compare adverse effects and analgesic efficacy of low-dose ketamine for acute pain in the ED administered either by single intravenous push (IVP) or short infusion (SI).
Patients 18-65, presenting to ED with acute abdominal, flank, or musculoskeletal pain with initial pain score≥5, were randomized to ketamine 0.3mg/kg by either IVP or SI with placebo double-dummy. Adverse effects were evaluated by Side Effects Rating Scale for Dissociative Anesthetics (SERSDA) and Richmond Agitation-Sedation Scale (RASS) at 5, 15, 30, 60, 90, and 120min post-administration; analgesic efficacy was evaluated by Numerical Rating Scale (NRS).
48 patients enrolled in the study. IVP group had higher overall rates of feeling of unreality on SERSDA scale: 92% versus 54% (difference 37.5%; p=0.008; 95% CI 9.3-59.5%). At 5min median severity of feeling of unreality was 3.0 for IVP versus 0.0 for SI (p=0.001). IVP also showed greater rates of sedation on RASS scale at 5min: median RASS -2.0 versus 0.0 (p=0.01). Decrease in mean pain scores from baseline to 15min was similar across groups: 5.2±3.53 (95% CI 3.7-6.7) for IVP; 5.75±3.48 (95% CI 4.3-7.2) for SI. There were no statistically significant differences with respect to changes in vital signs and need for rescue medication.
Low-dose ketamine given as a short infusion is associated with significantly lower rates of feeling of unreality and sedation with no difference in analgesic efficacy in comparison to intravenous push.
比较低剂量氯胺酮通过单次静脉推注（IVP）或短时间输注（SI）用于急诊科急性疼痛时的不良反应和镇痛效果。
年龄在18 - 65岁之间、因急性腹部、胁腹或肌肉骨骼疼痛就诊于急诊科且初始疼痛评分≥5分的患者，采用双盲安慰剂对照，随机分为接受IVP或SI方式给予0.3mg/kg氯胺酮的两组。在给药后5、15、30、60、90和120分钟，通过解离麻醉药副作用评定量表（SERSDA）和里士满躁动 - 镇静量表（RASS）评估不良反应；通过数字评定量表（NRS）评估镇痛效果。
48例患者纳入研究。IVP组在SERSDA量表上出现不真实感的总体发生率更高：92% 对比54%（差异37.5%；p = 0.008；95%可信区间9.3 - 59.5%）。在5分钟时，IVP组不真实感的中位严重程度为3.0，而SI组为0.0（p = 0.001）。IVP组在5分钟时在RASS量表上的镇静发生率也更高：RASS中位值为 - 2.0对比0.0（p = 0.01）。从基线到15分钟，两组平均疼痛评分的降低相似：IVP组为5.2±3.53（95%可信区间3.7 - 6.7）；SI组为5.75±3.48（95%可信区间4.3 - 7.2）。在生命体征变化和急救药物需求方面无统计学显著差异。
与静脉推注相比，短时间输注低剂量氯胺酮时不真实感和镇静发生率显著更低，镇痛效果无差异。
