Sub-dissociative dose ketamine administration for managing pain in the emergency department

BACKGROUND: We describe our experience of utilizing sub-dissociative dose ketamine (SDK) in managing a variety of acute and chronic painful conditions in the emergency department (ED). METHODS: A descriptive study was conducted in our ED over a period of seven years (2010-2016) by retrospectively reviewing charts of patients aged 18 and older presenting to the ED with painful complaints and receiving SDK analgesia. Primary data analyses included type of SDK administration (intravenous push [IVP], short-infusion [SI] or continuous infusion [CI]), dosing, rates of analgesic utilization before and after SDK administration, and adverse effects. RESULTS: Three hundred sixty-two patients were enrolled in the study. Mean ketamine doses given by IVP, SI and CI were 26.3 mg, 23.4 mg, and 11.3 mg. The mean duration of CI was 135.87 minutes. The percentage of patients not requiring post-SDK analgesia increased by 16%, 18%, and 37% in IVP, SI and CI groups. Adverse effects were recorded for 13% of patients. CONCLUSION: SDK administered by IVP, SI, and CI in the ED for a variety of painful conditions is a feasible analgesic modality in the ED that is associated with a decrease in overall requirements of post-ketamine analgesia and opioid sparing.