Low-Dose Intravenous Ketamine Bolus versus Conventional Technique for the Reduction of Upper and Lower Extremity Fractures in Children: A Randomised Controlled Clinical Trial

Aim: Ketamine administration in high dosage leads to certain adverse reactions. This study aimed to evaluate the effect of low-dose intravenous ketamine bolus versus conventional injection for the reduction of upper and lower extremity fractures in children. Materials and Methods: A total of 198 paediatric patients with extremity fractures were enrolled. They were randomly categorized into two groups. In the intervention group, a number of 100 patients participated with a mean age of 8.89 +/- 4.37, among them 77 (77%) were male and upper limb fractures were more common (84%). They were assigned to receive 1% ketamine at a dose of 0.5 mg/kg (within 5 s), and in the control group, a number of 98 patients participated with a mean age of 9.08 +/- 3.98, among them 73 (74.5%) were male and upper limb fractures were more common (83.7%). They received ketamine at 1.5 mg/kg for 30-60 s. The outcomes were measured, and the satisfaction of patients and physicians was recorded. Results: Successful sedation rate was significantly lower in the low-dose ketamine group than in the control group (7% vs 100%; p<0.001). Moreover, the duration of drug effect and recovery rate were significantly lower in the low-dose ketamine group than in the high-dose ketamine group (p<0.05). In addition, the rates of neurological (20.4% vs 5%) and physiological (10.2% vs 2%) side effects were significantly higher in the control group than in the intervention group (p<0.05). Conclusion: The findings of this study did not show that low-dose intravenous ketamine bolus had any beneficial effects in sedating paediatric patients, suggesting that it should not be considered as an accompaniment for standard therapy in short-term pain control.