{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T05:59:59Z","timestamp":1782712799234,"version":"3.54.5"},"reference-count":28,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2015,2,25]],"date-time":"2015-02-25T00:00:00Z","timestamp":1424822400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2015,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Ketamine is a well\u2010known anesthetic with its use trailing back to the 1960s. It has antagonistic effects at the<jats:italic>N<\/jats:italic>\u2010methyl\u2010<jats:sc>d<\/jats:sc>\u2010aspartate receptor. There is emerging literature to suggest the use of subdissociative\u2010dose ketamine (<jats:styled-content style=\"fixed-case\">SDDK<\/jats:styled-content>) for pain reduction. This evidence\u2010based review evaluates the evidence regarding the use of<jats:styled-content style=\"fixed-case\">SDDK<\/jats:styled-content>for acute pain control in the emergency department (<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The<jats:styled-content style=\"fixed-case\">MEDLINE<\/jats:styled-content>and<jats:styled-content style=\"fixed-case\">EMBASE<\/jats:styled-content>databases were searched. Randomized controlled trials (<jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>s) that described or evaluated the use of<jats:styled-content style=\"fixed-case\">SDDK<\/jats:styled-content>for acute pain in the<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>were included. Literature was excluded if it was not published in English. Duplicate articles, unpublished reports, abstracts, and review articles were also excluded. Quality assessment and evaluation of literature were evaluated based on the<jats:styled-content style=\"fixed-case\">GRADE<\/jats:styled-content>criteria. The primary outcome of interest in this review was the difference in pain score from baseline to cutoff time as specified in the studies. Secondary outcome measures were the incidence of adverse events and reduction in the amount of adjuvant opioids consumed by patients who received<jats:styled-content style=\"fixed-case\">SDDK<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Four<jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>s met the inclusion criteria, which enrolled a total of 428 patients. Three adult trials and one pediatric trial were identified. The level of evidence for the individual trials ranged from low to moderate. A significant reduction in pain scores was only found in two of the four trials. One trial found a significant reduction in mean pain scores when ketamine was compared to morphine (p\u00a0&lt;\u00a00.05). Another trial reported a significant decrease in mean distress scores, favoring<jats:styled-content style=\"fixed-case\">SDDK<\/jats:styled-content>over fentanyl (1.0 vs. 2.7, p\u00a0&lt;\u00a00.05). One trial found a significant reduction in the amount of morphine consumed, favoring ketamine over placebo (0.14\u00a0mg\/kg, 95% confidence interval [<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>]\u00a0=\u00a00.13 to 0.16\u00a0mg\/kg vs. 0.2\u00a0mg\/kg, 95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0=\u00a00.18 to 0.22\u00a0mg\/kg; p\u00a0&lt;\u00a00.001). An emergence phenomenon was reported in one trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Four<jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>s with methodologic limitations failed to provide convincing evidence to either support or refute the use of<jats:styled-content style=\"fixed-case\">SDDK<\/jats:styled-content>for acute pain control in the<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.12604","type":"journal-article","created":{"date-parts":[[2015,2,25]],"date-time":"2015-02-25T19:43:36Z","timestamp":1424893416000},"page":"251-257","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":48,"title":["The Use of Subdissociative\u2010dose Ketamine for Acute Pain in the Emergency Department"],"prefix":"10.1111","volume":"22","author":[{"given":"Billy","family":"Sin","sequence":"first","affiliation":[{"name":"The 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