Clinical Conundrum: Can nebulized ketamine be used for pain management in the ED for adults and pediatric patients when IV access is not available?
Background:
Ketamine is a dissociative agent that produces anesthesia through hallucinogenic, amnestic, analgesic, and cataleptic effect that can cause disorientation and emergence phenomenon. It is routinely used IV or IM.
Nebulized ketamine has recently been used for managing pain in the ED in providing rapid, effective, and non-invasive pain relief.
Answer:
In a recent Annals of Emergency Medicine study in 2021 looking at nebulized ketamine for analgesic efficacy and adverse effects showed that there is no difference between 3 dosing regimens (0.75, 1, and 1.5 mg/kg) . All were administered through a breath-actuated nebulizer for short term treatment of moderate to severe pain in ED.
In another Critical Care Medicine study in 2020 that focused on nebulized ketamine for acute and chronic pain control found statistically significant pain relief in 30 minutes and but no statistically significant pain relief among the different doses (0.75, 1, and 1.5mg/kg).
In a case series report in 2021 looking at pediatric patients in the ED showed that nebulized ketamine in doses (0.75, 1, and 1.5mg/kg) may be an effective, rapid, and a noninvasive pain relief administration route in the pediatric population.
Bottom line:
Nebulized ketamine can be used as an alternative for pain management in both adults and pediatrics.
Written by:
Ngoc Vo, PharmD
Pharmacy Resident, PGY-1
Reviewed By:
Joanne C. Routsolias, PharmD, RN, BCPS
Clinical PharmD Specialist - Emergency Medicine/Toxicology
References:
Dove, D., Fassassi, C., & Davis, A. et al (2021). Comparison of Nebulized ketamine at three different dosing regimens for treating painful conditions in the emergency department: A Prospective, Randomized, Double-Blind Clinical Trial. Annals Of Emergency Medicine. doi: 10.1016/j.annemergmed.2021.04.031
Motov, S., Fassassi, C., & Likourezos, A., et al. (2020). 945: Nebulized ketamine at three different doses for acute and chronic pain in the ed. Critical Care Medicine, 48(1), 452-452. doi: 10.1097/01.ccm.0000633316.55187.04
Zerzan, J., Rhodes, A., & Fagan, M. , et al. (2021). Nebulized ketamine for managing acute pain in the pediatric emergency department: A case series. Turkish Journal Of Emergency Medicine, 21(2), 75. doi: 10.4103/2452-2473.313334