How Does Ketamine Decrease The Use Of Opioids In The Emergency Room?

Ketamine was approved for commercial purposes in 1970. At the beginning, the manufacturer of this drug labeled it as a quick acting local anesthetic which did not contain any barbiturates. Ketamine was believed to be very beneficial for small outpatient procedures to control pain. Although over the years various other methods have come into existence but ketamine still holds its position due to its unique old and some newly found properties. Ketamine is now widely used for a variety of clinical applications.[1,2,3]

It has been found recently that ketamine is a good antiinflammatory and is also quite an effective neuroprotective agent. Ketamine when used in high dosages provides amnestic and anesthetic effects and when used in low doses provide an analgesic and antiinflammatory effect. Ketamine also has opioid sparing properties which makes it a perfect alternative to opioids for pain control in small procedures and in the emergency room.[1,2,3]

Even though there is ample amount of evidence suggesting the efficacy and safety of ketamine, there are many healthcare providers that even now hesitate to vouch for its use due to its potential for habituation and misuse. There have been new guidelines issued by the American Society and Anesthesiologists, American Society of Regional Anesthesia and Pain Medicine, and American Academy of Pain Medicine to identify patients that are more likely to benefit from ketamine use in a setting of acute pain especially in the emergency room.[1,2,3] The article below highlights how ketamine can decrease the use of opioids in the emergency room.

How Does Ketamine Decrease The Use Of Opioids In The Emergency Room?

A meta-analysis done recently highlights the analgesic properties of ketamine in comparison to those opioids in an emergency room setting. It was the conclusion of the researchers doing the metal analysis that ketamine is in fact a safe and effective alternative to opioids for pain control. Opioids for long have been a relatively safe and quite an effective way of treating acute pain. However, the rapid misuse of opioids over the years have forced researchers to look for other alternatives for treating pain, especially in the emergency room.[3]

Aside from opioid addiction, there are also other factors that also go against wide use of opioids. As an example, opioids have been known to cause respiratory depression in the elderly population which is quite a serious side effect. Additionally, opioids are not suggested for people with certain cardiovascular issues, seizures, or people who have a history of substance abuse.[3]

The researchers also opine that while it is not necessary to replace all forms of opioids but having an alternative is always a good option. This is where ketamine comes into the picture. Even though physicians are apprehensive about use of ketamine due to its use as a recreational drug in the past, it cannot be denied that it is an extremely effective analgesic and anesthetic. Since its approval in 1970, ketamine has been tried to treat various other conditions like depression and migraines as well. It has also been seen that there are no tolerance problems with ketamine and it does not have any serious side effect profile.[3]

To study and compare the effects of an opioid like morphine and ketamine and whether it is really effective and safe enough to replace opioids, researchers from Washington University School of Medicine in Missouri did a meta-analysis and performed a detailed study of both morphine and ketamine in an emergency room setting.

After searching for relevant studies, only three studies which met their criteria for selection were found. These three studies involved 261 patients.[3]

The authors of these studies were then contacted for more detailed information about the studies and what they revealed. The findings of the meta-analysis were published in the journal Academic Emergency Medicine. The researchers after thoroughly analyzing the details of the studies came to the conclusion that both morphine and ketamine were more or less equal when it comes to efficacy in an emergency room setting.[3]

Additionally, there were no severe adverse events reported in any study due to ketamine but there were mild events noted with ketamine use. Dr. Evan Schwarz who is a study author states that ketamine can be a good, effective, and safe alternative to opioids for acute pain in emergency room setting.[3]

However, the authors of the study are not in any way stating that opioids should be completely removed as a treatment option for pain control but they state that physicians should be confident of using ketamine as well in such situations. The authors of the study do admit to the fact that the sample size for the study was small but the analysis clearly points towards ketamine being an alternative to opioids to treat pain in the emergency room.[3]

The researchers’ state that more studies and research is ongoing to better ascertain this and to instill more confidence in physicians about the use of ketamine as an alternative to opioids for pain.[3]

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