Seak Yee Sin, Nor Junainah, Tuan Kamauzaman Tuan Hairulnizam, Arithra Ariff, Islam Md Asiful
Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia.
Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia.
J Clin Med. 2021 Sep 2;10(17):3978. doi: 10.3390/jcm10173978.
Due to overcrowding, personnel shortages, or problematic intravenous (IV) cannulation, acute pain management is often sub-optimal in emergency departments (EDs). The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of intranasal (IN) ketamine for adult acute pain in the emergency setting. We searched and identified studies up to 21 May 2021 via PubMed, Scopus, Web of Science, Cochrane Database, and Google Scholar. The random-effects model with 95% confidence intervals (CIs) was used to estimate mean differences (MDs) and odds ratios (ORs). The statistic and Cochran's Q test were used to determine heterogeneity. The protocol was registered in PROSPERO (CRD42020213391). Seven randomised controlled trials were included with a total of 1760 patients. There was no significant difference in pain scores comparing IN ketamine with IV analgesics or placebo at 5 (MD 0.94, = 0.26), 15 (MD 0.15, = 0.74), 25 (MD 0.24, = 0.62), 30 (MD -0.05, = 0.87), and 60 (MD -0.42, = 0.53) minutes. There was also no significant difference in the need for rescue analgesics between IN ketamine and IV analgesics (OR 1.66, 95% CI: 0.57-4.86, = 0.35, = 70%). Only mild adverse effects were observed in patients who received IN ketamine. Our results suggest that IN ketamine is non-inferior to IV analgesics and may have a role in acute pain management among adults in the ED.
由于过度拥挤、人员短缺或静脉（IV）插管困难，急诊科（EDs）的急性疼痛管理往往不尽人意。本系统评价和荟萃分析的目的是评估鼻内（IN）氯胺酮用于成人急诊急性疼痛的疗效和安全性。我们通过PubMed、Scopus、Web of Science、Cochrane数据库和谷歌学术搜索并识别了截至2021年5月21日的研究。采用95%置信区间（CIs）的随机效应模型来估计平均差（MDs）和比值比（ORs）。 统计量和 Cochr an Q检验用于确定异质性。该方案已在PROSPERO（CRD42020213391）中注册。纳入了7项随机对照试验，共1760例患者。在5（MD 0.94， = 0.26）、15（MD 0.15， = 0.74）、25（MD 0.24， = 0.62）、30（MD -0.05， = 0.87）和60（MD -0.42， = 0.53）分钟时，比较IN氯胺酮与IV镇痛药或安慰剂的疼痛评分无显著差异。IN氯胺酮与IV镇痛药之间在需要急救镇痛药方面也无显著差异（OR 1.66，95%CI：0.57 - 4.86， = 0.35， = 70%）。接受IN氯胺酮的患者仅观察到轻微不良反应。我们的结果表明，IN氯胺酮不劣于IV镇痛药，可能在急诊科成人急性疼痛管理中发挥作用。
