Intranasal Ketamine for Acute Pain

Objectives: The aim was to review current evidence regarding the off-label use of intranasal ketamine for acute pain presenting in the setting of the emergency department, and secondary to pediatric limb injuries, renal colic, digital nerve block, and migraines. Results: In all 5 indications reviewed, ketamine demonstrated efficacy in reducing pain. However, when compared with other agents, ketamine did not demonstrate superiority over opioids in pediatric limb injuries or renal colic and was not as efficacious as standard therapy for migraine relief. Ketamine was also associated with a greater incidence of transient adverse reactions, such as dizziness, bitter aftertaste, fatigue, and vomiting than opioid therapies. Discussion: The current body of evidence is insufficient to support the use of intranasal ketamine over other standard therapies for acute pain. However, current evidence can be used when developing dosing strategies, preparing for adverse reactions, and generating hypotheses for future, more robust research

Comparing the analgesic effect of intranasal with intravenous ketamine in isolated orthopedic trauma: A randomized clinical trial

Objectives: Ketamine is commonly used in anesthetic and sedation before surgical procedures and acts as an analgesic in smaller doses. The aim of this study was to assess the effects of intranasal (IN) ketamine in patients with moderate to severe limb trauma (visual analog scale (VAS) > 60 mm). Methods: In a triple-blind randomized controlled clinical trial; 154 patients with isolated orthopedic trauma and visual analog scale (VAS) ≥60 mm were included on the basis of inclusion and exclusion criteria. Patients were divided into two groups of ketamine-IN (0.4 mg/kg IN ketamine and an equal volume of placebo saline intravenously (IV)) and ketamine-IV (0.2 mg/kg ketamine IV with 0.5 ml saline IN) on the basis of balanced block randomization method. At 5, 10, 20, and 30 min, patients were assessed for VAS measurement and adverse events. Repeated measure ANOVA, independent t-test and chi square test were employed. The level of statistical significance was considered to be less than 0.05. Results: Mean VAS in IN ketamine and IV group at minute 30 was 31.50 ± 13.40 and 29.35 ± 11.73, respectively. At minute 30, 31 patients (20.39%) required a low-dose of morphine as rescue analgesia (P = 0.427). The results showed that mean change score of VAS (difference of time 0 and time 30) in IN ketamine and IV ketamine VAS were 43.8 (95% confidence interval: 41.1–46.5) and 46.4 (95% confidence interval: 42.8–50.1) and there is no difference between two groups in case of score change of VAS (P = 0.245). Adverse events in nasal and intravenous ketamine in both groups were mild and transient. Conclusion: IN ketamine is associated with few side effects and appropriate analgesic effects in isolated orthopedic trauma patients, and it may be used in cases where there is no need for venipuncture of peripheral vessels, especially in crowded EDs. Keywords: Ketamine, Intranasal, Pain, Emergenc

THE EFFECT OF AROMATHERAPY WITH ORANGE ESSENTIAL OIL ON ANXIETY AND PAIN IN PATIENTS WITH FRACTURED LIMBS ADMITTED TO AN EMERGENCY WARD: A RANDOMIZED CLINICAL TRIAL

Aim: Pain and anxiety are unpleasant feelings associated with actual or potential tissue damage. The goal of this study is to determine the effect of aromatherapy with orange oil on the pain and anxiety of patients with limb fractures hospitalized in an emergency ward. Design: Randomized Clinical Trial. Methods: 60 patients in an emergency ward were allocated to one of two groups: an experimental and a control group, using a randomized blocking sampling method. Four drops of orange oil were poured onto a pad, which was attached to his/her collar by a plastic safety pin (posing no risk to patients), so that the distance from the patient’s head was not more than 20 cm. To prevent loss of aroma from the impregnated pad, the fragrance was replaced every hour. Pain was measured every hour for six hours, and the patients’ anxiety rate was measured before and after the intervention. All data were analysed using SPSS 21. Results: Mean age of participants was 37.93 ± 18.19 years. Most fractures were in the scapula area (11 patients – 18.3%). The results indicated a significant difference between the mean of anxiety in the intervention group (p < 0.001) compared to the control group (p = 0.339). Regarding pain, a Friedman test showed significant differences between the mean of pain in the intervention group (p < 0.001) compared to the control group (p = 0.339). Conclusion: Aromatherapy with orange essential oil reduced pain and anxiety in patients with limb fractures. Therefore, the application of aromatherapy with orange essential oil as a complementary therapy is recommended for these patients. Keywords: aromatherapy, anxiety, limb fracture, orange oil, pain, relief