PMID- 29775117
OWN - NLM
STAT- MEDLINE
DCOM- 20200825
LR  - 20200825
IS  - 1545-0066 (Electronic)
IS  - 1090-3127 (Linking)
VI  - 23
IP  - 1
DP  - 2019 Jan-Feb
TI  - Intravenous Low-Dose Ketamine Provides Greater Pain Control Compared to Fentanyl 
      in a Civilian Prehospital Trauma System: A Propensity Matched Analysis.
PG  - 1-8
LID - 10.1080/10903127.2018.1469704 [doi]
AB  - Objective: A few studies report comparable analgesic efficacy between low-dose 
      ketamine and opioids such as morphine or fentanyl; however, limited research has 
      explored the safety and effectiveness of intravenous low-dose ketamine as a 
      primary analgesic in a civilian prehospital setting. The objective of this study 
      is to compare pain control between low-dose ketamine and fentanyl when 
      administered intravenously (IV) for the indication of severe pain. Methods: This 
      was a retrospective, observational review of prehospital adult patients 
      (>/=18 years) who presented with severe pain (numeric rating scale, 7-10) and were 
      treated solely with either low-dose ketamine IV or fentanyl IV between January 1, 
      2014 and December 31, 2016. Propensity matched analysis was performed adjusting 
      for all baseline variables with p </= 0.10 and for baseline pain score to match 
      ketamine and fentanyl patients on a one-to-one ratio. The primary outcome was 
      change in pain score from baseline to after treatment and evaluated with a paired 
      t-test. Secondary outcomes were changes in vital signs and Glasgow coma scale 
      (GCS) from baseline to after treatment, as well as incidence of clinically 
      significant adverse events (AEs); AEs were followed from scene arrival through 
      emergency department discharge. Results: Propensity matched analysis produced 79 
      matched pairs. Ketamine IV patients, receiving a mean (SD) dose of 0.3 (0.1) 
      mg/kg, showed a significantly larger mean decrease in pain after treatment, 
      compared to the fentanyl IV patients (-5.5 (3.1) vs. -2.5 (2.4), p < 0.001). A 
      significantly greater proportion of patients receiving ketamine IV achieved at 
      least a 50% reduction in pain compared to those receiving fentanyl IV (67% vs. 
      19%, p < 0.001), marking 52 ketamine IV patients as responders to treatment. 
      Vital signs demonstrated a nonsignificant decrease in blood pressure, respiratory 
      rate, heart rate, and GCS. No clinically significant AEs were reported for 
      patients receiving ketamine IV. Conclusion: The significant reduction in pain, 
      significantly high proportion of ketamine responders, and the lack of clinically 
      significant AEs characterizing patients receiving low-dose ketamine IV compared 
      to fentanyl IV, all provide further support for its use as an effective 
      prehospital analgesic. Level of Evidence: Level III, therapeutic.
FAU - Bronsky, E Stein
AU  - Bronsky ES
FAU - Koola, Catherine
AU  - Koola C
FAU - Orlando, Alessandro
AU  - Orlando A
FAU - Redmond, Diane
AU  - Redmond D
FAU - D'Huyvetter, Cecile
AU  - D'Huyvetter C
FAU - Sieracki, Heather
AU  - Sieracki H
FAU - Tanner, Allen 2nd
AU  - Tanner A 2nd
FAU - Fowler, Ray
AU  - Fowler R
FAU - Mains, Charles
AU  - Mains C
FAU - Bar-Or, David
AU  - Bar-Or D
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Observational Study
DEP - 20180518
PL  - England
TA  - Prehosp Emerg Care
JT  - Prehospital emergency care
JID - 9703530
RN  - 0 (Analgesics, Opioid)
RN  - 690G0D6V8H (Ketamine)
RN  - UF599785JZ (Fentanyl)
SB  - IM
MH  - Administration, Intravenous
MH  - Adult
MH  - Aged
MH  - Analgesics, Opioid/*administration & dosage
MH  - *Emergency Medical Services
MH  - Female
MH  - Fentanyl/*administration & dosage
MH  - Humans
MH  - Ketamine/*administration & dosage
MH  - Male
MH  - Middle Aged
MH  - Pain/*drug therapy/etiology
MH  - Pain Management
MH  - Pain Measurement
MH  - Propensity Score
MH  - Retrospective Studies
OTO - NOTNLM
OT  - fentanyl
OT  - intravenous
OT  - low-dose ketamine
OT  - pain control
OT  - prehospital
EDAT- 2018/05/19 06:00
MHDA- 2020/08/26 06:00
CRDT- 2018/05/19 06:00
PHST- 2018/05/19 06:00 [pubmed]
PHST- 2020/08/26 06:00 [medline]
PHST- 2018/05/19 06:00 [entrez]
AID - 10.1080/10903127.2018.1469704 [doi]
PST - ppublish
SO  - Prehosp Emerg Care. 2019 Jan-Feb;23(1):1-8. doi: 10.1080/10903127.2018.1469704. 
      Epub 2018 May 18.