{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T23:57:34Z","timestamp":1790812654182,"version":"4.1.0"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,12]]},"abstract":"\n Objective:<\/jats:title>\n Children in the emergency department (ED) experience distress due to many factors, such as pain. Although ketamine has analgesic and sedative effects, its parenteral administration causes pain and anxiety. It is notable that ketamine can be administered intranasally for analgesia. We hypothesized that the administration of intranasal (IN) ketamine for analgesia before intramuscular ketamine injection would diminish the injection pain without any adverse effect.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n This study was a randomized, double-blind, placebo-controlled clinical trial conducted in the ED. The IN ketamine group received a dose of 1.5\u00a0mg\/kg intranasally diluted to 1\u00a0mL, while the placebo group received 1\u00a0mL of sterile water. Injection pain was assessed using the FLACC scale (0 to 10), encompassing the face, leg, activity, cry, and consolability. Sedation time and adverse effects were also assessed.<\/jats:p>\n <\/jats:sec>\n \n Result:<\/jats:title>\n \n Eighty-four patients were enrolled. While the median (IQR) injection pain score in the placebo group was 10 (10 to 10), it was 1 (0 to 5) in the intervention group (\n P<\/jats:italic>\n <0.001). The sedation time in the control group was 80.9\u00b133.6 minutes and 86.4\u00b119.8 in the intervention arm (\n P=<\/jats:italic>\n 0.07). After excluding intraoral procedures, 7 (16.7%) and 2 (4.2%) patients had vomiting in the intervention and placebo groups, respectively. In addition, 3 (7%) patients of the IN-ketamine group had hypoventilation that was resolved with simple airway maneuvers.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Although IN ketamine demonstrated efficacy in reducing injection-related pain, its adverse event profile may limit its practicality in routine settings.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/pec.0000000000003485","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T05:00:15Z","timestamp":1758517215000},"page":"e233-e236","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["The Effectiveness of Intranasal Ketamine on Intramuscular Ketamine Injection Pain Among Children in the Emergency Department, a Randomized, Controlled Trial"],"prefix":"10.1097","volume":"41","author":[{"given":"Hadi","family":"Mirfazaelian","sequence":"first","affiliation":[{"name":"Emergency Medicine Department, Tehran University of Medical Sciences"},{"name":"Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali Salar","family":"Darafshi","sequence":"additional","affiliation":[{"name":"Emergency Medicine Department, Tehran University of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mojtaba","family":"Sedaghat","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0975-4322","authenticated-orcid":false,"given":"Hamideh","family":"Akbari","sequence":"additional","affiliation":[{"name":"Emergency Medicine Department, Tehran University of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,9,22]]},"reference":[{"key":"R1-20251201","doi-asserted-by":"crossref","first-page":"e1391","DOI":"10.1542\/peds.2012-2536","article-title":"Relief of pain and anxiety in pediatric patients in emergency medical systems","volume":"130","author":"Fein","year":"2012","journal-title":"Pediatrics"},{"key":"R2-20251201","doi-asserted-by":"crossref","first-page":"2587","DOI":"10.1542\/peds.2006-2780","article-title":"Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update","volume":"118","author":"C\u00f4t\u00e9","year":"2006","journal-title":"Pediatrics"},{"key":"R3-20251201","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/S0140-6736(14)61686-X","article-title":"Current concepts in management of pain in children in the emergency department","volume":"387","author":"Krauss","year":"2016","journal-title":"Lancet"},{"key":"R4-20251201","doi-asserted-by":"crossref","first-page":"e4","DOI":"10.1016\/j.ajem.2019.158445","article-title":"Does intramuscular ondansetron have an effect on intramuscular ketamine- associated vomiting in children? 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