Alongside the potential for addiction, there are a number of other reasons to use alternative analgesics for acute pain in the emergency room (ER).
For instance, in older patients, opioids can cause respiratory depression, which can be dangerous. And, if an individual has a substance use disorder, a seizure disorder, or certain cardiovascular problems, opioids are not always an ideal choice.
Although replacing opioids entirely is not necessary, having other options available is useful and will help reduce their overall usage.
Ketamine’s new dawn
Although ketamine has become infamous for its use as a recreational drug, it is an effective anesthetic; ketamine has been used in a medical setting since its approval by the Food and Drug Administration (FDA) in 1970.
Despite the drug’s image problem, ketamine is effective, relatively safe, and well-tolerated. It is worth mentioning, however, that its dissociative psychological effects can be disturbing for some patients.
Importantly, in stark contrast to opioids, ketamine is not particularly addictive and does not cause respiratory depression.
Perhaps surprisingly, there has been little research into whether ketamine might be a viable replacement for opioids when managing acute pain. Although regularly used to bolster the effects of opioids, it is used on its own much less often. This could be due to clinicians’ lack of confidence in its effectiveness.
Recently, a group of researchers from the Washington University School of Medicine in St. Louis, MO, conducted a meta-analysis to get a better understanding of how well ketamine performs when it is provided alone to treat acute pain in an ER setting. The team wanted to understand whether it is at least as effective as opioids.
After searching for relevant trials to analyze, just three met their stringent criteria. In all, the studies involved 261 patients. The researchers contacted the authors of the three studies, who provided them with access to more detailed, patient-level information.
Their findings were published in the journal Academic Emergency Medicine.
Confident ketamine use
The authors concluded that ketamine was not inferior to morphine. Importantly, “no severe adverse events were reported in any study.” However, there were higher rates of nonsevere adverse events with ketamine use.
Ketamine appears to be a legitimate and safe alternative to opioids for treating acute pain in the emergency department. Emergency physicians can feel comfortable using it instead of opioids.”
Senior study author Dr. Evan Schwarz
Although the authors are certainly not calling for opioids to be removed from ERs, they hope that clinicians will feel confident using ketamine in its place when appropriate.
Although, as the authors acknowledge, the analysis was carried out on a relatively small sample, it adds to the evidence in favor of ketamine use in the ER. More work is sure to follow.
What do anesthesiologists do?Anesthiologists play a key role in surgery but they have other tasks, from managing the patient’s condition during a procedure to advising on pain relief.
Respiratory depression: Causes, symptoms, and treatmentRespiratory depression occurs when a person’s breathing rate and depth is especially low. This can cause potentially life-threatening complications, such as coma. Symptoms include slow and shallow breathing. Read on to find out the causes and symptoms of respiratory depression, as well as how it is treated.
What’s to know about general anesthesia?Surgeons have used general anesthetics since 1842. They induce a reversible coma, but researchers are still not entirely sure how this effect is achieved. What are the differences between local and general anesthesia? We find answers and discuss risks and side effects. Learn more about general anesthesia here.
Can you withdraw from opiate addiction at home?There are many symptoms of opiate withdrawal, including shaking, chills, nausea, and diarrhea in some cases. These uncomfortable symptoms can often be relieved through home treatments until the body is entirely free of opiates. Learn more about the potential home remedies for opiate withdrawal symptoms here.
What are the uses of ketamine?Ketamine is an anesthetic, used to induce a loss of consciousness and relieve pain. It is commonly abused for its hallucinogenic and dissociative effects and, controversially, it may be prescribed to treat depression. Learn more about the recommended uses and adverse mental and physical effects of misuse here.
On – 23 Jul, 2018 By Tim Newman