Lower Ketamine Dose Can Provide Pain Relief for Acute Pain in ER

PainRelief.com Interview with:
Shannon Lovett, MD, FACEP
Associate Professor
Associate Medical Director, ED Clinical Operations
Department of Emergency Medicine
Stritch School of Medicine

Dr. Lovett

PainRelief.com:  What is the background for this study?  What types of pain were treated?

Response: The opioid crisis has led emergency medicine providers to utilize other medications to treat pain, including ketamine. Prior to our study, there was a range of recommended ketamine doses in the treatment of pain, and the most frequently studied dose demonstrating analgesic efficacy was 0.3 mg/kg. We challenged that dose by comparing a lower dose, 0.15 mg/kg, to 0.3 mg/kg of IV ketamine for acute moderate to severe pain in the emergency department. We treated acute (onset < 7 days) abdominal, back, flank, musculoskeletal, and headache pain. 

PainRelief.com: What are the main findings? Does ketamine have significant addictive potential?

Response: We found that at 30 minutes, 0.15 mg/kg of IV ketamine provided similar pain relief to 0.3 mg/kg. Like most medications that have analgesic or sedative effects, ketamine does have addictive potential. However, certain characteristics of ketamine make the potential for addiction or dependence significantly lower than drugs such as opioids. And,it is likely that utilizing lower doses would also decrease potential for tolerance or dependence. 

PainRelief.com: What should readers take away from your report?

Response: We know from previous research that the adverse effects of ketamine tend to be dose dependent. Since we did not find a significant difference in the level of pain control attained between the higher dose 0.3 mg/kg when compared to 0.15 mg/kg, providers should consider utilizing 0.15 mg/kg as a starting dose when treating acute pain in the emergency department. 

PainRelief.com: What recommendations do you have for future research as a result of this work?

Response: More research is needed to help us understand what type of patients respond best to ketamine for pain. For example, ketamine may a safe and reliable option for analgesia in patients that are opioid tolerant. 

PainRelief.com: Is there anything else you would like to add?

Response: As we continue with our research, we hope to find data that supports diminished adverse effects with the lower dose of ketamine with equal efficacy in treating pain. 

No disclosures. 

Citation:

Shannon Lovett et al, A randomized, noninferiority, controlled trial of two doses of intravenous subdissociative ketamine for analgesia in the emergency department, Academic Emergency Medicine (2020). DOI: 10.1111/acem.14200

The information on PainRelief.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.