Yousefifard Mahmoud, Askarian-Amiri Shaghayegh, Rafiei Alavi Seyedeh Niloufar, Sadeghi Mostafa, Saberian Peyman, Baratloo Alireza, Talebian Mohammad Taghi
Physiology Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Department of Anesthesiology and Critical Care, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Arch Acad Emerg Med. 2019 Oct 30;8(1):e1. eCollection 2020.
Although previous articles and reviews suggest that ketamine might effectively manage pain in trauma patients, these articles have serious limitations. Accordingly, the current meta-analysis aims to investigate the efficacy of ketamine administration in prehospital pain management of trauma patients.
In the present meta-analysis, controlled human studies were included. An extensive search was conducted in electronic databases including Medline (via PubMed), Embase, Central, Scopus, Web of Science, and ProQuest, gathering data to the end of 2018. The efficacy and side effects of ketamine administration in pre-hospital pain management were compared with those of opioid analgesics based on standard mean difference (SMD) and odds ratio (OR) calculations with 95% confidence interval (95% CI).
Data from seven articles were included in the present meta-analysis. Ketamine administration was not more effective than administrating morphine or fentanyl in prehospital pain management of trauma patients (SMD = -0.56, 95% CI: -1.38 to 0.26, p = 0.117). However, co-administration of ketamine+morphine was considerably more effective than ketamine alone, in alleviating pain in prehospital settings (SMD = -0.62, 95% CI: -1.12 to -0.12, p = 0.010). Finally, it was concluded that ketamine alone had less side effects than morphine alone (OR = 0.25, 95% CI: 0.11 to 0.56, p = 0.001). However, co-administration of ketamine+morphine increases the risk of side effects to 3.68 times compared to when morphine is prescribed solely (OR=3.68, 95% CI: 1.99 to 6.82, p<0.001).
For the first time, findings of the current meta-analysis demonstrated that ketamine, being administered alone, is an effective and safe medication in prehospital pain management in trauma patients, and can be considered as an acceptable alternative to opioid analgesics.
尽管先前的文章和综述表明氯胺酮可能有效管理创伤患者的疼痛，但这些文章存在严重局限性。因此，当前的荟萃分析旨在研究氯胺酮给药在创伤患者院前疼痛管理中的疗效。
在本荟萃分析中，纳入了对照人体研究。在包括Medline（通过PubMed）、Embase、Central、Scopus、Web of Science和ProQuest在内的电子数据库中进行了广泛搜索，收集截至2018年底的数据。基于标准平均差（SMD）和比值比（OR）计算以及95%置信区间（95%CI），比较了氯胺酮给药在院前疼痛管理中的疗效和副作用与阿片类镇痛药的疗效和副作用。
本荟萃分析纳入了7篇文章的数据。在创伤患者的院前疼痛管理中，氯胺酮给药并不比给予吗啡或芬太尼更有效（SMD = -0.56，95%CI：-1.38至0.26，p = 0.117）。然而，氯胺酮+吗啡联合给药在缓解院前疼痛方面比单独使用氯胺酮显著更有效（SMD = -0.62，95%CI：-1.12至-0.12，p = 0.010）。最后得出结论，单独使用氯胺酮的副作用比单独使用吗啡少（OR = 0.25，95%CI：0.11至o.56，p = 0.001）。然而，与单独开具吗啡相比，氯胺酮+吗啡联合给药使副作用风险增加到3.68倍（OR = 3.68，95%CI：1.99至6.82，p<0.001）。
当前荟萃分析的结果首次表明，单独使用氯胺酮在创伤患者院前疼痛管理中是一种有效且安全的药物，可被视为阿片类镇痛药的可接受替代药物。
