The use of ketamine in pain management in comparison to other analgesia in the Emergency Department: a systematic review

Objectives
Pain is a great contributor for visits to the Emergency Department (ED). There are different sorts of analgesia that can be given to ease the pain of the patients.
To see if ketamine could be used for pain reduction in the ED, we performed a clinical literature search.
Methods
We searched on September 13th, 2021, for articles in the databases PubMed, EMBASE, and the Cochrane library. One reviewer screened the articles for comparison studies in adult patients presenting with pain in the ED treated with ketamine and compared to other analgesia. One reviewer evaluated the risk of bias for the included articles. The primary outcome was the reduction in pain scores, and secondary outcomes were the need for rescue analgesia and the occurrence of adverse events.
Results
After extraction 11 studies were included in this review with a total of 1466 patients. 733 patients did get ketamine as intervention and the other half did get as comparison morphine, fentanyl, nitrous oxide, or ketorolac.
There was no difference in the use of ketamine for pain reduction compared to other analgesia. Nor was there a significant difference for the need of rescue analgesia or the occurrence of adverse events.
A meta-analysis was not possible through the high heterogeneity between the studies.
Conclusion
Based on the most recent evidence regarding the use of ketamine as an analgesic drug, ketamine is as effective as other analgesic drugs that are used in the ED with no significant difference in the occurrence of adverse events or need for rescue analgesia. So, ketamine could be a new possibility in the ED for pain management.