The Efficacy of Ketamine Administration in Prehospital Pain Management of Trauma Patients; a Systematic Review and Meta-Analysis
Introduction: Although previous articles and reviews suggest that ketamine might effectively manage pain in trauma patients, these articles have serious limitations. Accordingly, the current meta-analysis aims to investigate the efficacy of ketamine administration in prehospital pain management of t...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Shahid Beheshti University of Medical Sciences
2020-01-01
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| Series: | Archives of Academic Emergency Medicine |
| Subjects: | |
| Online Access: | https://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/479 |
| _version_ | 1811300383858884608 |
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| author | Mahmoud Yousefifard Shaghayegh Askarian-Amiri Seyedeh Niloufar Rafiei Alavi Mostafa Sadeghi Peyman Saberiana Alireza Baratloo Mohammad Taghi Talebian |
| author_facet | Mahmoud Yousefifard Shaghayegh Askarian-Amiri Seyedeh Niloufar Rafiei Alavi Mostafa Sadeghi Peyman Saberiana Alireza Baratloo Mohammad Taghi Talebian |
| author_sort | Mahmoud Yousefifard |
| collection | DOAJ |
| description | Introduction: Although previous articles and reviews suggest that ketamine might effectively manage pain in trauma patients, these articles have serious limitations. Accordingly, the current meta-analysis aims to investigate the efficacy of ketamine administration in prehospital pain management of trauma patients.
Method: In the present meta-analysis, controlled human studies were included. An extensive search was conducted in electronic databases including Medline (via PubMed), Embase, Central, Scopus, Web of Science, and ProQuest, gathering data to the end of 2018. The efficacy and side effects of ketamine administration in pre-hospital pain management were compared with those of opioid analgesics based on standard mean difference (SMD) and odds ratio (OR) calculations with 95% confidence interval (95% CI).
Results: Data from seven articles were included in the present meta-analysis. Ketamine administration was not more effective than administrating morphine or fentanyl in prehospital pain management of trauma patients (SMD = -0.56, 95% CI: -1.38 to 0.26, p = 0.117). However, co-administration of ketamine+morphine was considerably more effective than ketamine alone, in alleviating pain in prehospital settings (SMD = -0.62, 95% CI: -1.12 to -0.12, p = 0.010). Finally, it was concluded that ketamine alone had less side effects than morphine alone (OR = 0.25, 95% CI: 0.11 to 0.56, p = 0.001). However, co-administration of ketamine+morphine increases the risk of side effects to 3.68 times compared to when morphine is prescribed solely (OR=3.68, 95% CI: 1.99 to 6.82, p<0.001).
Conclusion: For the first time, findings of the current meta-analysis demonstrated that ketamine, being administered alone, is an effective and safe medication in prehospital pain management in trauma patients, and can be considered as an acceptable alternative to opioid analgesics. |
| first_indexed | 2024-04-13T06:50:31Z |
| format | Article |
| id | doaj.art-7afbdea5c7ee49b39621b47416dcc3a5 |
| institution | Directory Open Access Journal |
| issn | 2645-4904 |
| language | English |
| last_indexed | 2024-04-13T06:50:31Z |
| publishDate | 2020-01-01 |
| publisher | Shahid Beheshti University of Medical Sciences |
| record_format | Article |
| series | Archives of Academic Emergency Medicine |
| spelling | doaj.art-7afbdea5c7ee49b39621b47416dcc3a52022-12-22T02:57:25ZengShahid Beheshti University of Medical SciencesArchives of Academic Emergency Medicine2645-49042020-01-018110.22037/aaem.v8i1.479350The Efficacy of Ketamine Administration in Prehospital Pain Management of Trauma Patients; a Systematic Review and Meta-AnalysisMahmoud Yousefifard0Shaghayegh Askarian-AmiriSeyedeh Niloufar Rafiei AlaviMostafa Sadeghi1Peyman SaberianaAlireza Baratloo2Mohammad Taghi Talebian3Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran Iran.Department of Anesthesiology and Critical Care, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.1. Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2. Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.Introduction: Although previous articles and reviews suggest that ketamine might effectively manage pain in trauma patients, these articles have serious limitations. Accordingly, the current meta-analysis aims to investigate the efficacy of ketamine administration in prehospital pain management of trauma patients. Method: In the present meta-analysis, controlled human studies were included. An extensive search was conducted in electronic databases including Medline (via PubMed), Embase, Central, Scopus, Web of Science, and ProQuest, gathering data to the end of 2018. The efficacy and side effects of ketamine administration in pre-hospital pain management were compared with those of opioid analgesics based on standard mean difference (SMD) and odds ratio (OR) calculations with 95% confidence interval (95% CI). Results: Data from seven articles were included in the present meta-analysis. Ketamine administration was not more effective than administrating morphine or fentanyl in prehospital pain management of trauma patients (SMD = -0.56, 95% CI: -1.38 to 0.26, p = 0.117). However, co-administration of ketamine+morphine was considerably more effective than ketamine alone, in alleviating pain in prehospital settings (SMD = -0.62, 95% CI: -1.12 to -0.12, p = 0.010). Finally, it was concluded that ketamine alone had less side effects than morphine alone (OR = 0.25, 95% CI: 0.11 to 0.56, p = 0.001). However, co-administration of ketamine+morphine increases the risk of side effects to 3.68 times compared to when morphine is prescribed solely (OR=3.68, 95% CI: 1.99 to 6.82, p<0.001). Conclusion: For the first time, findings of the current meta-analysis demonstrated that ketamine, being administered alone, is an effective and safe medication in prehospital pain management in trauma patients, and can be considered as an acceptable alternative to opioid analgesics.https://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/479Pain ManagementAnalgesicsOpioidNon-NarcoticEmergency Medical ServicesKetamine |
| spellingShingle | Mahmoud Yousefifard Shaghayegh Askarian-Amiri Seyedeh Niloufar Rafiei Alavi Mostafa Sadeghi Peyman Saberiana Alireza Baratloo Mohammad Taghi Talebian The Efficacy of Ketamine Administration in Prehospital Pain Management of Trauma Patients; a Systematic Review and Meta-Analysis Archives of Academic Emergency Medicine Pain Management Analgesics Opioid Non-Narcotic Emergency Medical Services Ketamine |
| title | The Efficacy of Ketamine Administration in Prehospital Pain Management of Trauma Patients; a Systematic Review and Meta-Analysis |
| title_full | The Efficacy of Ketamine Administration in Prehospital Pain Management of Trauma Patients; a Systematic Review and Meta-Analysis |
| title_fullStr | The Efficacy of Ketamine Administration in Prehospital Pain Management of Trauma Patients; a Systematic Review and Meta-Analysis |
| title_full_unstemmed | The Efficacy of Ketamine Administration in Prehospital Pain Management of Trauma Patients; a Systematic Review and Meta-Analysis |
| title_short | The Efficacy of Ketamine Administration in Prehospital Pain Management of Trauma Patients; a Systematic Review and Meta-Analysis |
| title_sort | efficacy of ketamine administration in prehospital pain management of trauma patients a systematic review and meta analysis |
| topic | Pain Management Analgesics Opioid Non-Narcotic Emergency Medical Services Ketamine |
| url | https://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/479 |
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