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Analgesic alternatives are being explored in response to an epidemic of opioid misuse. Low\u2010dose ketamine (<jats:styled-content style=\"fixed-case\">LDK<\/jats:styled-content>) is one opioid alternative for the treatment of acute pain in the <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>This systematic review and meta\u2010analysis sought to quantify whether <jats:styled-content style=\"fixed-case\">LDK<\/jats:styled-content> is an effective and safe opioid alternative for acute pain reduction in adults in the <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> setting. (<jats:styled-content style=\"fixed-case\">PROSPERO<\/jats:styled-content> Registration Number <jats:styled-content style=\"fixed-case\">CRD<\/jats:styled-content>42017065303).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a systematic review of randomized controlled trials comparing intravenous opioids to <jats:styled-content style=\"fixed-case\">LDK<\/jats:styled-content> for relief of acute pain in the <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>. Studies where the control group initially received opioids prior to ketamine were excluded. A research librarian designed the electronic search strategy. Changes in visual analog scale or numeric rating scale pain scales were analyzed to determine the relative effects of <jats:styled-content style=\"fixed-case\">LDK<\/jats:styled-content> and opioids in the treatment of acute pain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Three studies met the criteria for inclusion in this meta\u2010analysis. Compared to pain scale reduction with morphine, ketamine was not inferior (relative reduction = 0.42, 95% confidence interval = \u20130.70 to 1.54). No severe adverse events were reported in any study, but higher rates of nonsevere adverse events were observed with ketamine.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Ketamine is noninferior to morphine for the control of acute pain, indicating that ketamine can be considered as an alternative to opioids for <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> short\u2010term pain control.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.13502","type":"journal-article","created":{"date-parts":[[2018,7,19]],"date-time":"2018-07-19T02:21:20Z","timestamp":1531966880000},"page":"1086-1097","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":81,"title":["A Systematic Review and Meta\u2010analysis of Ketamine as an Alternative to Opioids for Acute Pain in the Emergency Department"],"prefix":"10.1111","volume":"25","author":[{"given":"Nicholas","family":"Karlow","sequence":"first","affiliation":[{"name":"Washington University School of Medicine St. Louis MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles H.","family":"Schlaepfer","sequence":"additional","affiliation":[{"name":"Washington University School of Medicine St. Louis MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn R. 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