The Efficacy of Ketamine Administration in Prehospital Pain Management of Trauma Patients; a Systematic Review andMeta -Analysis

Introduction: Although previous articles and reviews suggest that ketamine might effectively manage pain in trauma patients, these articles have serious limitations. Accordingly, the current meta-analysis aims to investigate the efficacy of ketamine administration in prehospital pain management of trauma patients.Method: In the present meta-analysis, controlled human studies were included. An extensive search was conducted in electronic databases including Medline (via PubMed), Embase, Central, Scopus, Web of Science, and ProQuest, gathering data to the end of ۲۰۱۸. The efficacy and side effects of ketamine administration in pre-hospital pain management were compared with those of opioid analgesics based on standard mean difference (SMD) and odds ratio (OR) calculations with ۹۵% confidence interval (۹۵% CI).Data from seven articles were included in the presentmeta-analysis.Ketamine administration was not more effective than administrating morphine or fentanyl in prehospital pain management of trauma patients (SMD = -۰.۵۶, ۹۵% CI: -۱.۳۸ to ۰.۲۶, p = ۰.۱۱۷). However, co-administration of ketamine+morphine was considerably more effective than ketamine alone, in alleviating pain in prehospital settings (SMD = -۰.۶۲, ۹۵% CI: -۱.۱۲ to -۰.۱۲, p = ۰.۰۱۰). Finally, it was concluded that ketamine alone had less side effects than morphine alone (OR = ۰.۲۵, ۹۵% CI: ۰.۱۱ to ۰.۵۶, p =۰.۰۰۱).However, co-administration of ketamine+morphineincreases the risk of side effects to ۳.۶۸ times compared to when morphine is prescribed solely (OR=۳.۶۸, ۹۵% CI: ۱.۹۹ to ۶.۸۲, p<۰.۰۰۱).Conclusion: For the first time, findings of the current meta-analysis demonstrated that ketamine, being administered alone, is an effective and safe medication in prehospital pain management in trauma patients, and can be considered as an acceptable alternative to opioid analgesics.

کلیدواژه ها:

PainManagement ، Analgesics ، Opioid ، Analgesics ، Non-Narcotic ، EmergencyMedical Services ، Ketamine