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 3–13 years, with moderate to severe (≥6/10) pain from isolated limb injury. IN ketamine was administered at enrolment, with a supplementary dose after 15 min, if required. Primary outcome was change in median pain rating at 30 min. Secondary outcomes included change in median pain rating at 60 min, 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 ] 6–10). Twenty‐three (82.1%) were male. Eighteen (64%) received only one dose of IN ketamine (mean dose 0.84 mg/kg), whereas 10 (36%) required a second dose at 15 min (mean for second dose 0.54 mg/kg). The total mean dose for all patients was 1.0 mg/kg (95% CI : 0.92–1.14). The median pain rating decreased from 74.5 mm ( IQR 60–85) to 30 mm ( IQR 12–51.5) at 30 min ( P < 0.001, M ann– W hitney). For the 24 children who contributed data at 60 min, the median pain rating was 25 mm ( IQR 4–44). 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 1.0 mg/kg IN ketamine provided adequate analgesia by 30 min for most patients.