Efficacy and safety of low-dose ketamine for acute pain management

Recent interest in low-dose ketamine (LDK) for acute pain relief in emergency departments (EDs) has prompted a systematic review and meta-analysis to evaluate its effectiveness and safety compared to morphine. Eight randomized controlled trials (RCTs) involving 1,191 patients were analyzed. Results showed that there was no significant difference in mean pain scores between LDK and morphine within the first 60 minutes post-administration. Morphine had a slight edge in pain relief at the 60 to 120-minute mark, but this was not clinically significant. The need for rescue analgesia was similar between both groups, as were adverse effects such as nausea and hypoxia. 

Ketamine’s unique pharmacological profile, including its dissociative properties and preservation of airway reflexes, makes it a viable alternative for patients who may not be ideal candidates for opioid therapy, such as those with a history of substance misuse or chronic opioid use. Given its comparable effectiveness and safety, LDK could be particularly beneficial in clinical scenarios where opioids are contraindicated or less effective. Further research is needed to explore LDK’s long-term safety and efficacy, especially in specific populations like those on naltrexone or buprenorphine. Despite the need for more robust data, this analysis supports the consideration of LDK as an alternative analgesic in EDs.