Safety And Efficacy of Prehospital Paramedic Administration of Ketamine In Adult Civilian Population.

Objective: Opiates are addicting and have a high potential for dependency. Opiate-related overdoses now claim 130 American lives each day, and the opiate epidemic costs nearly $80 billion annually. In past decades, opiates were a mainstay of prehospital treatment for acute traumatic pain in the civilian population. Ketamine is a N-methyl-d-aspartate receptor antagonist that has analgesic properties and may serve as an alternative agent for the treatment of acute traumatic pain in the prehospital setting. This study aimed to assess the safety and efficacy of ketamine administration by paramedics in a civilian prehospital setting for the treatment of acute traumatic pain. Design and Method: This was a prospective, observational study conducted in the counties of San Bernardino, Riverside and Stanislaus in the state of California. The inclusion criteria were patients > 15 years of age with complaint of traumatic or burn-related pain. We excluded patients if they had received opiates prior to or concurrently with ketamine administration. Dose administered was 0.3 milligrams per kilogram (mg/kg) intravenously over five minutes with maximum dose of 30mg. Option to administer a second dose was available to paramedics if the patient continued to have pain after 15 minutes following the first administration. We conducted paired-T tests to assess the change in the primary outcome (pain score) and secondary outcomes (eg, systolic blood pressure [SBP], respiratory rate, and pulse). P value <0.05 was considered to be statistically significant. Results: We included 368 patients in the final analysis. The average age was 52.9 ± 23.1 years old, and the average weight was 80.4 ± 22.2 kg. There was a statistically significant reduction in the pain score (9.13 ± 1.28 vs 3.7 ± 3.4, delta = 5.43 ± 3.38, p<0.0001). Additionally, there was a statistically significant change in SBP (143.42 ± 27.01 vs 145.65 ± 26.26, 2.22 ± 21.1, p = 0.0440), pulse (88.06 ± 18 vs 84.64 ± 15.92, delta = -3.42 ± 12.12, p<0.0001), and respiratory rate (19.04 ± 3.59 vs 17.74 ± 3.06, delta = -1.3 ± 2.96, p<0.0001). Conclusion: This study suggests that the administration of a subdissociative dose of ketamine by paramedics in the prehospital setting is an effective analgesic in selected adult trauma patients. Additionally, ketamine did not demonstrate the adverse effects (eg, respiratory failure or hypotension) typically seen in opioid administration. [ABSTRACT FROM AUTHOR]