Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Emergency Department, Alzahra University Hospital, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Am J Emerg Med. 2021 Oct;48:48-53. doi: 10.1016/j.ajem.2021.03.055. Epub 2021 Apr 3.
Pain control is an important aspect of ED patient management, and there are many different protocols used around the world influenced by both availability of local resources as well as staff competency and experience. This study aims to evaluate the use of topical ketamine in acute pain reduction by directly comparing it to lidocaine-prilocaine (EMLA) cream.
In this randomized clinical trial, 300 adult patients classified as level 4 or 5 by ESI triage system were enrolled. These patients were divided randomly into three groups. The site of venipuncture was covered with 2 g of topical ketamine cream 10% in group one, 2 g of 5% EMLA cream in group two, and finally, in group 3 (control group), was covered with placebo (2 g of cold cream). The primary end point of the study was reported pain severity with secondary end points being onset of local anesthesia as well as any side effects noted.
The data gathered showed pain score during venipuncture in both intervention groups were significantly lower when compared to the control group (P < 0.05). However, pain score did not differ between the 2 intervention groups (P = 0.395). There was no statistically significant difference between the ketamine or EMLA in onset of local anesthesia (P = 0.419). We noted itching and irritation was significantly higher in the EMLA group when compared to ketamine(P < 0.05).
This study showed that local cutaneous ketamine is as effective as EMLA in relieving pain during venipuncture.
疼痛控制是 ED 患者管理的一个重要方面，世界各地有许多不同的方案，这些方案受到当地资源的可用性以及工作人员的能力和经验的影响。本研究旨在通过直接比较利多卡因-丙胺卡因（EMLA）乳膏来评估局部应用氯胺酮在急性疼痛缓解中的作用。
在这项随机临床试验中，纳入了 300 名按 ESI 分诊系统分类为 4 级或 5 级的成年患者。这些患者被随机分为三组。在第一组中，用 2 g 10%的局部氯胺酮乳膏覆盖静脉穿刺部位，在第二组中，用 2 g 5%的 EMLA 乳膏覆盖，最后，在第三组（对照组）中，用 2 g 冷霜覆盖安慰剂。该研究的主要终点是报告的疼痛严重程度，次要终点是局部麻醉的起效以及注意到的任何副作用。
收集的数据显示，与对照组相比，两组干预组在静脉穿刺时的疼痛评分明显较低（P < 0.05）。然而，两组干预组之间的疼痛评分无差异（P = 0.395）。氯胺酮或 EMLA 对局部麻醉的起效无统计学差异（P = 0.419）。与氯胺酮相比，EMLA 组的瘙痒和刺激明显更高（P < 0.05）。
本研究表明，局部皮肤应用氯胺酮在缓解静脉穿刺疼痛方面与 EMLA 一样有效。
