{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:43:00Z","timestamp":1787013780594,"version":"build-2736575974"},"reference-count":32,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,1,2]],"date-time":"2021-01-02T00:00:00Z","timestamp":1609545600000},"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":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>There has been increased interest in the use of low\u2010dose ketamine (LDK) as an alternative analgesic for the management of acute pain in the emergency department (ED). The objective of this systematic review was to compare the analgesic effectiveness and safety profile of LDK and morphine for acute pain management in the ED.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Electronic searches of Medline and EMBASE were conducted and reference lists were hand\u2010searched. Randomized controlled trials (RCTs) comparing LDK to morphine for acute pain control in the ED were included. Two reviewers independently screened abstracts, assessed quality of the studies, and extracted data. Data were pooled using random\u2010effects models and reported as mean differences and risk ratios (RRs) with 95% confidence intervals (CIs). We used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty of the evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eight RCTs were included with a total of 1,191 patients (LDK\u00a0=\u00a0598, morphine\u00a0=\u00a0593). There was no significant difference in reported mean pain scores between LDK and morphine within the first 60\u00a0minutes after analgesia administration and a slight difference in pain scores favoring morphine at 60 to 120\u00a0minutes. The need for rescue medication was also similar between groups (RR\u00a0=\u00a01.26, 95% CI\u00a0= 0.50 to 3.16), as was the proportion of patients who experienced nausea (RR\u00a0=\u00a00.97, 95% CI\u00a0= 0.63 to 1.49) and hypoxia (RR\u00a0=\u00a00.38, 95% CI\u00a0= 0.10 to 1.41). All outcomes were judged to have low certainty in the evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Low\u2010dose ketamine and morphine had similar analgesic effectiveness within 60\u00a0minutes of administration with comparable safety profiles, suggesting that LDK is an effective alternative analgesic for acute pain control in the ED.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acem.14159","type":"journal-article","created":{"date-parts":[[2020,10,24]],"date-time":"2020-10-24T12:17:11Z","timestamp":1603541831000},"page":"444-454","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":61,"title":["Low\u2010dose Ketamine For Acute Pain Control in the Emergency Department: A Systematic Review and Meta\u2010analysis"],"prefix":"10.1111","volume":"28","author":[{"given":"Nathan","family":"Balzer","sequence":"first","affiliation":[{"name":"From the Department of Medicine Division of Emergency Medicine University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelley L.","family":"McLeod","sequence":"additional","affiliation":[{"name":"the Department of Family and Community Medicine University of Toronto Toronto Ontario Canada"},{"name":"the Schwartz\/Reisman Emergency Medicine Institute Sinai Health Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Walsh","sequence":"additional","affiliation":[{"name":"and the Sinai Health Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2252-1371","authenticated-orcid":false,"given":"Keerat","family":"Grewal","sequence":"additional","affiliation":[{"name":"From the Department of Medicine Division of Emergency Medicine University of Toronto Toronto Ontario Canada"},{"name":"the Schwartz\/Reisman Emergency Medicine Institute Sinai Health Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,1,2]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/ajem.2002.32643"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2006.12.005"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40122-017-0090-5"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13722-018-0117-1"},{"key":"e_1_2_7_6_1","first-page":"1","article-title":"Identification of substance\u2010involved emergency department visits using data from the national hospital care survey","volume":"114","author":"Brown AM","year":"2018","journal-title":"Natl Health Stat Report"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12873-019-0236-3"},{"key":"e_1_2_7_8_1","unstructured":"National Center for Biotechnology Information.PubChem Compound Summary for CID 3821 Ketamine. Available at:https:\/\/pubchem.ncbi.nlm.nih.gov\/compound\/Ketamine. Accessed Aug 15 2020."},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2010.11.030"},{"key":"e_1_2_7_10_1","volume-title":"Airway Management in Emergencies","author":"Beatty L","year":"2020"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.4103\/0259-1162.143110"},{"key":"e_1_2_7_12_1","unstructured":"American College of Emergency Physicians (ACEP).Sub\u2010dissociative Ketamine for Analgesia: Policy Resource and Education Paper (PREP).2019. Available at:https:\/\/www.acep.org\/globalassets\/new\u2010pdfs\/preps\/sub\u2010dissociative\u2010dose\u2010ketamine\u2010for\u2010analgesia\u2013\u2010prep.pdfAccessed Aug 15 2020."},{"key":"e_1_2_7_13_1","first-page":"77","article-title":"Comparison of intravenous ketamine with morphine in pain relief of long bones fractures: a double blind randomized clinical trial","volume":"2","author":"Majidinejad S","year":"2014","journal-title":"Emerg (Tehran)"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2015.03.004"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.2174\/1574887114666190705122727"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.13502"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0165461"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12604"},{"key":"e_1_2_7_19_1","unstructured":"HigginsJP Savovi\u0107J PageMJ ElbersRG SterneJA.Chapter 8: Assessing risk of bias in a randomized trial. In: Higgins JP Thomas J Chandler J et al. editors. Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). Cochrane 2019. Available at:https:\/\/training.cochrane.org\/handbook\/current\/chapter\u201008Accessed Aug 15 2020."},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.04.026"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2018.05.030"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2014.12.058"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.29252\/beat-060105"},{"key":"e_1_2_7_24_1","first-page":"e60561","article-title":"Acute pain management in emergency department, low dose ketamine versus morphine, A randomized clinical trial","volume":"7","author":"Mahshidfar B","year":"2017","journal-title":"Anesth Pain Med"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2019.08.394"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1017\/cem.2017.48"},{"key":"e_1_2_7_27_1","unstructured":"Center for Substance Abuse Treatment.Incorporating Alcohol Pharmacotherapies into Medical Practice. Rockville MD: Substance Abuse and Mental Health Services Administration 2009. (Treatment Improvement Protocol (TIP) Series No. 49.) Chapter 4\u2010Oral Naltrexone. Available at:https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK64042\/. Accessed Aug 15 2020."},{"key":"e_1_2_7_28_1","volume-title":"StatPearls [Internet]","author":"Kumar R","year":"2020"},{"key":"e_1_2_7_29_1","unstructured":"Center for Substance Abuse Treatment.Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction \u2013 A Treatment Improvement Protocol (TIP 40). Rockville MD: Substance Abuse and Mental Health Services Administration 2012. Available at:https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK64245\/pdf\/Bookshelf_NBK64245.pdf. Accessed Aug 15 2020."},{"key":"e_1_2_7_30_1","unstructured":"RogersE MehtaS ShengeliaR ReidMC.Four strategies for managing opioid\u2010induced side effects in older adults. Clin Geriatr 2013;21:http:\/\/www.consultant360.com\/articles\/four\u2010strategies\u2010managing\u2010opioid\u2010induced\u2010side\u2010effects\u2010older\u2010adults. Accessed Aug 15 2020."},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.05180418"},{"key":"e_1_2_7_32_1","unstructured":"American College of Emergency Physicians (ACEP).Policy Statement \u2010 Optimizing the Treatment of Acute Pain in the Emergency Department. Dallas TX: ACEP 2017. Available at:https:\/\/www.acep.org\/globalassets\/new\u2010pdfs\/policy\u2010statements\/optimizing\u2010the\u2010treatment\u2010of\u2010acute\u2010pain\u2010in\u2010the\u2010ed.pdf. 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