References
Intravenous ketamine as an analgesia in prehospital adult trauma patients
Abstract
Background:
Prehospital traumatic pain is common, but the quality of pain management in these patients is poor. Current practice recommends morphine as the first-line analgesia in major trauma but this carries high risks and is often contraindicated. Alternative paramedic-administered analgesia does not provide adequate pain relief or may be contraindicated. As a result, many patients remain in pain. Analgesic ketamine is used safely and effectively in international civilian and military settings and by paramedics with additional training, education and qualifications.
Aim:
The study had two aims. Namely, these were to find out whether intravenous ketamine: provides effective relief of prehospital traumatic pain in adults; and is safe for prehospital administration by non-specialist paramedics.
Method:
Three databases, CINAHL, MEDLINE and AMED, were searched to identify articles published between 2009 and 2021. Exclusion criteria were applied and results subjected to critical appraisal and evaluation.
Findings:
Four studies were included in the review. Two themes were identified for thematic analysis: therapeutic effectiveness; and the safety of IV ketamine administration by paramedics. The evidence drew predominantly homogenous conclusions, but was substandard regarding external validity, which limited the quality of these conclusions.
Conclusion:
Ketamine provides effective pain relief in line with morphine and is safe for paramedics to administer. However, clear gaps in the evidence mean the research questions are not fully answered, so changes to current paramedic practice cannot be recommended.
Pain is defined as ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’ (World Health Organization (WHO), 1986). It can be divided into several classes, with acute pain being commonplace within the prehospital environment.
Acute pain arises abruptly, often secondary to trauma, with trauma defined as ‘physical injury caused by violent or disruptive action’ (Mosby, 2016). Traumatic pain accounts for 35–70% of all prehospital cases of acute pain (Albrecht et al, 2013).
Despite its prevalence, acute pain experienced by trauma patients is greatly undertreated in emergency care (Scholten et al, 2015), with the majority of prehospital patients who experience acute pain still being in pain on admission to the emergency department (ED) (Jennings et al, 2011a). The frequency of acute pain within prehospital trauma patients combined with the pervasiveness of pain undertreatment shows improvements are needed in patient care.
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