Efficacy of intranasal cetamine for pain reduction in adults in emergency situations: a systematic literature review
DOI:
https://doi.org/10.29352/mill0218e.36563Keywords:
ketamine; intranasal ketamine; pain management; emergency medical servicesAbstract
Introduction: Pain is one of the most prevalent clinical manifestations in emergency settings. Traditionally, opiates have been widely used to control it, but in recent decades there has been a significant change in analgesic approaches, with growing interest in non-opiate alternatives. These include ketamine, whose pharmacological profile has aroused interest due to its analgesic efficacy, especially in situations of intense acute pain.
Objective To identify the use of intranasal ketamine to reduce pain in adults in emergency situations.
Methods: Systematic literature review, guided by the PI[C]OD search strategy, with extraction of articles supported by Rayyan software. Articles written in English, Portuguese, Spanish and/or French were taken into account, with a time frame between 2018-2023, searched in the PubMed and CINAHL complete databases and on the B-On online platform.
Results: Analysing the evidence from the three studies demonstrated the efficacy of using intranasal ketamine to reduce pain in emergency situations. Intranasal ketamine, when added to nitrous oxide, provided a significant reduction in pain, improved comfort compared to intranasal placebo and had fewer adverse reactions. However, the length of stay in the emergency department for patients receiving ketamine in a pre-hospital setting, as an alternative to morphine or fentanyl, may be less than desirable for adequate clinical monitoring, especially in the treatment of isolated non-cardiorespiratory pain conditions.
Conclusion: The use of intranasal ketamine seems to be effective in controlling acute pain in adults in emergency situations, but more randomised controlled studies are needed to strengthen the evidence found.
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