Sub-dissociative dose intranasal ketamine for limb injury pain in children in the emergency department: A pilot study

Objective The present study aims to conduct a pilot study examining the effectiveness of intranasal (IN) ketamine as an analgesic for children in the ED. Methods The present study used an observational study on a convenience sample of paediatric ED patients aged 313 years, with moderate to severe (6/10) pain from isolated limb injury. IN ketamine was administered at enrolment, with a supplementary dose after 15min, if required. Primary outcome was change in median pain rating at 30min. Secondary outcomes included change in median pain rating at 60min, patient/parent satisfaction, need for additional analgesia and adverse events being reported. Results For the 28 children included in the primary analysis, median age was 9 years (interquartile range [IQR] 610). Twenty-three (82.1%) were male. Eighteen (64%) received only one dose of IN ketamine (mean dose 0.84mg/kg), whereas 10 (36%) required a second dose at 15min (mean for second dose 0.54mg/kg). The total mean dose for all patients was 1.0mg/kg (95% CI: 0.921.14). The median pain rating decreased from 74.5mm (IQR 6085) to 30mm (IQR 1251.5) at 30min (P < 0.001, MannWhitney). For the 24 children who contributed data at 60min, the median pain rating was 25mm (IQR 444). Twenty (83%) subjects were satisfied with their analgesia. Eight (33%) were given additional opioid analgesia and the 28 reported adverse events were all transient and mild. Conclusions In this population, an average dose of 1.0mg/kg IN ketamine provided adequate analgesia by 30min for most patients.