Department of Emergency Medicine, Highland Hospital-Alameda Health System, Oakland, CA.
Department of Emergency Medicine, University of California, San Francisco, CA.
Acad Emerg Med. 2018 Sep;25(9):1048-1052. doi: 10.1111/acem.13428. Epub 2018 May 25.
We compared the analgesic efficacy and incidence of side effects when low-dose (0.3 mg/kg) ketamine (LDK) is administered as a slow infusion (SI) over 15 minutes versus an intravenous push (IVP) over 1 minute.
This was a prospective, randomized, double-blind, double-dummy, placebo-controlled trial of adult ED patients presenting with moderate to severe pain (numerical rating scale [NRS] score ≥ 5). Patients received 0.3 mg/kg ketamine administered either as a SI or a IVP. Our primary outcome was the proportion of patients experiencing any psychoperceptual side effect over 60 minutes. A secondary outcome was incidence of moderate or greater psychoperceptual side effects. Additional outcomes included reduction in pain NRS scores at 60 minutes and percent maximum summed pain intensity difference (%SPID).
Fifty-nine participants completed the study. A total of 86.2% of the IVP arm and 70.0% of the SI arm experienced any side effect (difference = 16.2%, 95% confidence interval [CI] = -5.4 to 37.8). We found a large reduction in moderate or greater psychoperceptual side effects with SI administration-75.9% reported moderate or greater side effects versus 43.4% in the SI arm (difference = 32.5%, 95% CI = 7.9 to 57.1). Additionally, the IVP arm experienced more hallucinations (n = 8, 27.6%) than the SI arm (SI n = 2, 6.7%, difference = 20.9%, 95% CI = 1.8 to 43.4). We found no significant differences in analgesic efficacy. At 60 minutes, the mean %SPID values in the IVP and SI arms were 39.9 and 33.5%, respectively, with a difference of 6.5% (95% CI = -5.8 to 18.7).
Most patients who are administered LDK experience a psychoperceptual side effect regardless of administration via SI or IVP. However, patients receiving LDK as a SI reported significantly fewer moderate or greater psychoperceptual side effects and hallucinations with equivalent analgesia.
我们比较了小剂量（0.3mg/kg）氯胺酮（LDK）以 15 分钟缓慢输注（SI）与 1 分钟静脉推注（IVP）方式给药时的镇痛效果和不良反应发生率。
这是一项前瞻性、随机、双盲、双模拟、安慰剂对照的研究，纳入了就诊于急诊科、伴有中重度疼痛（数字评分量表[NRS]评分≥5）的成年患者。患者接受 0.3mg/kg 氯胺酮，分别以 SI 或 IVP 方式给药。主要结局为 60 分钟内出现任何精神感觉不良反应的患者比例。次要结局为出现中重度精神感觉不良反应的发生率。其他结局包括 60 分钟时疼痛 NRS 评分的降低以及最大总和疼痛强度差值的百分比（%SPID）。
59 名患者完成了研究。IVP 组和 SI 组分别有 86.2%和 70.0%的患者出现任何不良反应（差异=16.2%，95%置信区间[CI]：-5.4 至 37.8）。我们发现 SI 给药可显著减少中重度精神感觉不良反应-75.9%的患者报告出现中重度不良反应，而 SI 组为 43.4%（差异=32.5%，95%CI：7.9 至 57.1）。此外，IVP 组出现幻觉的患者更多（8 例，27.6%），而 SI 组为 2 例（6.7%）（差异=20.9%，95%CI：1.8 至 43.4）。我们未发现镇痛效果的显著差异。在 60 分钟时，IVP 和 SI 组的平均%SPID 值分别为 39.9%和 33.5%，差异为 6.5%（95%CI：-5.8 至 18.7）。
无论采用 SI 还是 IVP 方式给予 LDK，大多数患者都会出现精神感觉不良反应。但接受 SI 给予 LDK 的患者报告出现中重度精神感觉不良反应和幻觉的比例显著更低，而镇痛效果相当。
