Side Effects and Adverse Events in Prehospital Ketamine Analgesia for Trauma

Introduction: In the United Kingdom, pain management is a frequent reason for ambulance use. The benefits of adequate pain management are well documented and have been shown to improve patient outcome and quality of life. Ketamine has been shown to be an effective analgesic in international prehospital settings, yet it does not feature in the scope of practice of all UK paramedics. The aim of this literature review is to identify the type and incidence of adverse events and side effects when Ketamine analgesia is administered for traumatic pain in the prehospital setting.Methods: A systematic electronic search was performed to identify literature documenting adverse events and side effects of analgesic ketamine in the prehospital setting. Additionally, manual reference screening and a snowballing technique were used to identify additional relevant material. A thematic analysis of their findings was undertaken to identify the range of side effects reported.Results: Eight studies, containing a total of 1301 patients, met the inclusion criteria of this review. Four were randomised controlled trials and four were retrospective database reviews. Thematic analysis of reported side effects included cardiovascular, neuropsychological or gastrointestinal effects , and airway or respiratory compromise. Additional effects such as hypertonia, clonus and allergic reactions were reported in three studies. Conclusion: A broad range of side effects were reported following analgesic ketamine for the treatment of traumatic pain. The incidence of serious adverse events was low. Variation in the dosing regimes, routes of administration, definitions of side effects, observation periods, and inclusion criteria was observed and may limit generalisability. This study provides an overview of the complications that may occur following administration and the requirement to carefully consider how Ketamine is utilized. When administered to appropriately selected and risk-assessed patients, Ketamine may be a useful tool in the paramedic’s pain management armoury.