October 2024 Pick of the Month

Just Do It

The discovery of the ketamine molecule dates back to 1962 at the Parke-Davis laboratories, where it was synthesized as a safer alternative to phencyclidine (PCP). Since then, ketamine has invoked clinical connotations ranging from “Ketamine elevates intracranial pressure and causes patients to freak out” to “Ketamine works great for procedural sedation in children.” 

Now, for the first time, Stine Fjendbo Galili and colleagues have conducted a randomized, placebo-controlled trial that included a heterogeneous population of emergency department (ED) patients with pain. In this month’s POTM, Low-dose ketamine as an adjunct to morphine: A randomized controlled trial among patients with and without current opioid use, the authors found that compared with placebo, patients receiving 0.1 mg/kg of ketamine had significant reductions in pain scores for the subsequent 30 minutes. 

Patients receiving ketamine experienced a higher incidence of dreamlike states, which for many, may not seem to be a bad thing. (Some ED doctors might muse that we should strive for a situation where most of our patients experience a dreamlike state). Taking everything into consideration, the work by Stine Fjendbo Galili et al. shows that ketamine offers the benefit of greater immediate pain reduction with a relatively benign profile of side effects. Maybe it is time to just do it.

Jeffrey A. Kline, MD
Wayne State University School of Medicine
Editor-in-Chief

Source: Kirsty Challen, BSc, MBChB, MRes, PhD, Lancashire Teaching Hospitals | AEM Editor of Infographics