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Efficacy and safety in ketamine-guided prehospital analgesia for abdominal pain

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Abstract

Abdominal pain is a common reason for presentation in the emergency department and for calling emergency medical services. The complexity of abdominal pain also influences the analgesia strategy. However, there are almost no data on the use of ketamine for abdominal pain. This study aims to analyze the safety and efficacy of using ketamine as an analgesic for abdominal pain. In a retrospective analysis of prehospital patient data within the framework of quality assurance, all cases with ketamine administered by paramedics as analgesia for abdominal pain were analyzed in terms of pain reduction and patient safety and also compared with other analgesic drugs including fentanyl, morphine, and metamizole. From 01/01/2018 to 11/24/2021, 129 datasets were analyzed. The mean patient age was 50 ± 19 years (19–90 years), with 47.3% (n = 61) women. The application of fentanyl was documented as a monotherapy in 10.9% (n = 14), morphine in 2.3% (n = 3), metamizole in 34.1% (n = 44), and ketamine in 52.7% (n = 68) of cases. The pain relief of fentanyl, metamizole, and ketamine differed significantly from each other (p < 0.001), with fentanyl and ketamine being comparable. Looking at the quality assurance definition of successful analgesia (pain on handover NRS < 5 or pain reduction ≥ 2 points), successful analgesia was shown in 92.9% (n = 13) of cases for fentanyl, in 65.9% (n = 44) for metamizole, and 92.6% (n = 68) for ketamine (p < 0.001). Adverse events were not observed in patients treated with ketamine. Analgesia is an important goal in the treatment of patients with abdominal pain. With ketamine, analgesia comparable to fentanyl can be achieved. Ketamine appears to be a safe and effective option for the treatment of patients with abdominal pain in emergency medicine.

Trial registration number DRKS00027343, date of registration: 09.12.2021, retrospectively registered.

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Acknowledgements

We would like to thank our paramedics, who always put the patient first and do an excellent job.

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Authors and Affiliations

  1. Center for Public Health and Health Services Research, University Hospital Tübingen, 72076, Tübingen, Germany

    David Häske

  2. Emergency Medical Service, German Red Cross, 72764, Reutlingen, Germany

    David Häske, Wolfgang Dorau, Niklas Heinemann, Fabian Eppler, Tobias Schopp & Benjamin Schempf

  3. Department of Internal Medicine, Cardiology, Angiology and Intensive Care Medicine, Klinikum am Steinenberg, 72764, Reutlingen, Germany

    Benjamin Schempf

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  1. David Häske
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  3. Niklas Heinemann
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  4. Fabian Eppler
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  5. Tobias Schopp
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  6. Benjamin Schempf
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Contributions

DH and BS led the overall project, WD, NH, FE, TS organized the implementation, and DH, NH, and BS were responsible for quality assurance. DH drafted the script, performed the statistical analyses. WD, NH, FE, TS, and BS added other discussion points. All authors read the manuscript and agreed to publication.

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Correspondence to David Häske.

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Häske, D., Dorau, W., Heinemann, N. et al. Efficacy and safety in ketamine-guided prehospital analgesia for abdominal pain. Intern Emerg Med 17, 2291–2297 (2022). https://doi.org/10.1007/s11739-022-03091-w

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