The Effectiveness of Intranasal Ketamine on Intramuscular Ketamine Injection Pain Among Children in the Emergency Department, a Randomized, Controlled Trial.

OBJECTIVE

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.

METHODS

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 mg/kg intranasally diluted to 1 mL, while the placebo group received 1 mL 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.

RESULT: 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 ( P <0.001). The sedation time in the control group was 80.9±33.6 minutes and 86.4±19.8 in the intervention arm ( P= 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.

CONCLUSION

Although IN ketamine demonstrated efficacy in reducing injection-related pain, its adverse event profile may limit its practicality in routine settings.