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Ketamine for the treatment of prehospital acute pain: a systematic review of benefit and harm

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Ketamine for the treatment of prehospital acute pain : a systematic review of benefit and harm. / Sandberg, Mårten; Hyldmo, Per Kristian; Kongstad, Poul; Dahl Friesgaard, Kristian; Raatiniemi, Lasse; Larsen, Robert; Magnusson, Vidar; Rognås, Leif; Kurola, Jouni; Rehn, Marius; Vist, Gunn Elisabeth.

In: BMJ Open, Vol. 10, No. 11, e038134, 11.2020.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

Harvard

Sandberg, M, Hyldmo, PK, Kongstad, P, Dahl Friesgaard, K, Raatiniemi, L, Larsen, R, Magnusson, V, Rognås, L, Kurola, J, Rehn, M & Vist, GE 2020, 'Ketamine for the treatment of prehospital acute pain: a systematic review of benefit and harm', BMJ Open, vol. 10, no. 11, e038134. https://doi.org/10.1136/bmjopen-2020-038134

APA

Sandberg, M., Hyldmo, P. K., Kongstad, P., Dahl Friesgaard, K., Raatiniemi, L., Larsen, R., Magnusson, V., Rognås, L., Kurola, J., Rehn, M., & Vist, G. E. (2020). Ketamine for the treatment of prehospital acute pain: a systematic review of benefit and harm. BMJ Open, 10(11), [e038134]. https://doi.org/10.1136/bmjopen-2020-038134

CBE

Sandberg M, Hyldmo PK, Kongstad P, Dahl Friesgaard K, Raatiniemi L, Larsen R, Magnusson V, Rognås L, Kurola J, Rehn M, Vist GE. 2020. Ketamine for the treatment of prehospital acute pain: a systematic review of benefit and harm. BMJ Open. 10(11):Article e038134. https://doi.org/10.1136/bmjopen-2020-038134

MLA

Vancouver

Author

Sandberg, Mårten ; Hyldmo, Per Kristian ; Kongstad, Poul ; Dahl Friesgaard, Kristian ; Raatiniemi, Lasse ; Larsen, Robert ; Magnusson, Vidar ; Rognås, Leif ; Kurola, Jouni ; Rehn, Marius ; Vist, Gunn Elisabeth. / Ketamine for the treatment of prehospital acute pain : a systematic review of benefit and harm. In: BMJ Open. 2020 ; Vol. 10, No. 11.

Bibtex

@article{44aceb9684ad4e4e8e278cd4f44a7cd6,
title = "Ketamine for the treatment of prehospital acute pain: a systematic review of benefit and harm",
abstract = "BACKGROUND: Few publications have addressed prehospital use of ketamine in analgesic doses. We aimed to assess the effect and safety profile of ketamine compared with other analgesic drugs (or no drug) in adult prehospital patients with acute pain.METHODS: A systematic review of clinical trials assessing prehospital administration of ketamine in analgesic doses compared with other analgesic drugs or no analgesic treatment in adults. We searched PubMed, EMBASE, Cochrane Library and Epistemonikos from inception until 15 February 2020, including relevant articles in English and Nordic languages. We used the Cochrane and Grading of Recommendations Assessment, Development and Evaluation methodologies and exclusively assessed patient-centred outcomes. Two independent authors screened trials for eligibility, extracted data and assessed risk of bias.RESULTS: We included eight studies (2760 patients). Ketamine was compared with various opioids given alone, and intranasal ketamine given with nitrous oxide was compared with nitrous oxide given alone. Four randomised controlled trials (RCTs) and one cluster randomised trial included 699 patients. One prospective cohort included 27 patients and two retrospective cohorts included 2034 patients. Five of the eight studies had high risks of bias. Pain score with ketamine is probably lower than after opioids as demonstrated in a cluster-RCT (308 patients) and a retrospective cohort (158 patients) study, Δvisual analogue scale -0.4 (-0.8 to 0.0) and Δnumeric pain rating scale -3.0 (-3.86 to -2.14), respectively. Ketamine probably leads to less nausea and vomiting (risk ratio (RR) 0.24 (0.11 to 0.52)) but more agitation (RR 7.81 (1.85 to 33)) than opioids.CONCLUSIONS: This systematic literature review finds that ketamine probably reduces pain more than opioids and with less nausea and vomiting but higher risk of agitation. Risk of bias in included studies is high.OTHER: Scandinavian society of anaesthesiology and intensive care medicine funded meetings and software. The Norwegian Air Ambulance Foundation funded publication. Otherwise this research received no grant from any agency in the public, commercial or not-for-profit sectors.PROSPERO REGISTRATION NUMBER: CRD42018114399.",
author = "M{\aa}rten Sandberg and Hyldmo, {Per Kristian} and Poul Kongstad and {Dahl Friesgaard}, Kristian and Lasse Raatiniemi and Robert Larsen and Vidar Magnusson and Leif Rogn{\aa}s and Jouni Kurola and Marius Rehn and Vist, {Gunn Elisabeth}",
note = "{\textcopyright} Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",
year = "2020",
month = nov,
doi = "10.1136/bmjopen-2020-038134",
language = "English",
volume = "10",
journal = "B M J Open",
issn = "2044-6055",
publisher = "BMJ Publishing Group",
number = "11",

}

RIS

TY - JOUR

T1 - Ketamine for the treatment of prehospital acute pain

T2 - a systematic review of benefit and harm

AU - Sandberg, Mårten

AU - Hyldmo, Per Kristian

AU - Kongstad, Poul

AU - Dahl Friesgaard, Kristian

AU - Raatiniemi, Lasse

AU - Larsen, Robert

AU - Magnusson, Vidar

AU - Rognås, Leif

AU - Kurola, Jouni

AU - Rehn, Marius

AU - Vist, Gunn Elisabeth

N1 - © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2020/11

Y1 - 2020/11

N2 - BACKGROUND: Few publications have addressed prehospital use of ketamine in analgesic doses. We aimed to assess the effect and safety profile of ketamine compared with other analgesic drugs (or no drug) in adult prehospital patients with acute pain.METHODS: A systematic review of clinical trials assessing prehospital administration of ketamine in analgesic doses compared with other analgesic drugs or no analgesic treatment in adults. We searched PubMed, EMBASE, Cochrane Library and Epistemonikos from inception until 15 February 2020, including relevant articles in English and Nordic languages. We used the Cochrane and Grading of Recommendations Assessment, Development and Evaluation methodologies and exclusively assessed patient-centred outcomes. Two independent authors screened trials for eligibility, extracted data and assessed risk of bias.RESULTS: We included eight studies (2760 patients). Ketamine was compared with various opioids given alone, and intranasal ketamine given with nitrous oxide was compared with nitrous oxide given alone. Four randomised controlled trials (RCTs) and one cluster randomised trial included 699 patients. One prospective cohort included 27 patients and two retrospective cohorts included 2034 patients. Five of the eight studies had high risks of bias. Pain score with ketamine is probably lower than after opioids as demonstrated in a cluster-RCT (308 patients) and a retrospective cohort (158 patients) study, Δvisual analogue scale -0.4 (-0.8 to 0.0) and Δnumeric pain rating scale -3.0 (-3.86 to -2.14), respectively. Ketamine probably leads to less nausea and vomiting (risk ratio (RR) 0.24 (0.11 to 0.52)) but more agitation (RR 7.81 (1.85 to 33)) than opioids.CONCLUSIONS: This systematic literature review finds that ketamine probably reduces pain more than opioids and with less nausea and vomiting but higher risk of agitation. Risk of bias in included studies is high.OTHER: Scandinavian society of anaesthesiology and intensive care medicine funded meetings and software. The Norwegian Air Ambulance Foundation funded publication. Otherwise this research received no grant from any agency in the public, commercial or not-for-profit sectors.PROSPERO REGISTRATION NUMBER: CRD42018114399.

AB - BACKGROUND: Few publications have addressed prehospital use of ketamine in analgesic doses. We aimed to assess the effect and safety profile of ketamine compared with other analgesic drugs (or no drug) in adult prehospital patients with acute pain.METHODS: A systematic review of clinical trials assessing prehospital administration of ketamine in analgesic doses compared with other analgesic drugs or no analgesic treatment in adults. We searched PubMed, EMBASE, Cochrane Library and Epistemonikos from inception until 15 February 2020, including relevant articles in English and Nordic languages. We used the Cochrane and Grading of Recommendations Assessment, Development and Evaluation methodologies and exclusively assessed patient-centred outcomes. Two independent authors screened trials for eligibility, extracted data and assessed risk of bias.RESULTS: We included eight studies (2760 patients). Ketamine was compared with various opioids given alone, and intranasal ketamine given with nitrous oxide was compared with nitrous oxide given alone. Four randomised controlled trials (RCTs) and one cluster randomised trial included 699 patients. One prospective cohort included 27 patients and two retrospective cohorts included 2034 patients. Five of the eight studies had high risks of bias. Pain score with ketamine is probably lower than after opioids as demonstrated in a cluster-RCT (308 patients) and a retrospective cohort (158 patients) study, Δvisual analogue scale -0.4 (-0.8 to 0.0) and Δnumeric pain rating scale -3.0 (-3.86 to -2.14), respectively. Ketamine probably leads to less nausea and vomiting (risk ratio (RR) 0.24 (0.11 to 0.52)) but more agitation (RR 7.81 (1.85 to 33)) than opioids.CONCLUSIONS: This systematic literature review finds that ketamine probably reduces pain more than opioids and with less nausea and vomiting but higher risk of agitation. Risk of bias in included studies is high.OTHER: Scandinavian society of anaesthesiology and intensive care medicine funded meetings and software. The Norwegian Air Ambulance Foundation funded publication. Otherwise this research received no grant from any agency in the public, commercial or not-for-profit sectors.PROSPERO REGISTRATION NUMBER: CRD42018114399.

U2 - 10.1136/bmjopen-2020-038134

DO - 10.1136/bmjopen-2020-038134

M3 - Journal article

C2 - 33234621

VL - 10

JO - B M J Open

JF - B M J Open

SN - 2044-6055

IS - 11

M1 - e038134

ER -