In adult patients presenting to ED with severe acute pain, is intranasal ketamine as effective as intravenous opiates for pain reduction?
Khilan Santilal, Rhea Saldanha
Emergency Medicine Journal May 30, 2025 DOI: 10.1136/emermed-2025-215080 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Peer reviewed |
|---|---|
| Population | Adults presenting to the emergency department with acute severe pain |
| Intervention | Intranasal ketamine |
| Topics | Esketamine Ketamine |
| Keywords | Emergency medicine Pain management analgesia Pain control Ketamine ketamine therapy Dissociative anesthetics Emergency department ed Emergency care Acute care Pain relief |
| Citations | 1 |
| Key findings | Intranasal ketamine provides pain relief comparable to intravenous morphine in this patient cohort, with a similar side effect profile. |
Abstract
This systematic review assessed whether intranasal (IN) ketamine is as effective as intravenous (IV) opiates for adults presenting to the ED with acute severe pain. EMBASE and Medline were searched, using relevant search terms, identifying four studies relevant to our three-part question. Key findings, as well as study weaknesses, were presented in a table. In summary, our results indicate that IN ketamine provides pain relief comparable to IV morphine in this patient cohort, with a similar side effect profile. However, the generalisability of these findings is limited owing to the lack of uniformity in study methodologies, short-term follow-up, broad exclusion criteria, sampling techniques and small sample sizes. Further studies regarding the role of IN ketamine in this setting would be worthwhile.
Comparable studies
Other systematic reviews and meta-analyses on ketamine, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| The effect of a single dose of intravenous ketamine on suicidal ideation: a systematic review and individual participant data meta-analysis Depressed patients with suicidal ideation at baseline | 2017 | Systematic review and individual participant data meta-analysis | n = 167 |
| Ketamine use: a review Ketamine users | 2011 | Systematic review | |
| Ketamine and Other NMDA Antagonists: Early Clinical Trials and Possible Mechanisms in Depression Participants with major depression in placebo-controlled, double-blind, randomized... | 2015 | Systematic review and meta-analysis | |
| Ketamine and postoperative pain – a quantitative systematic review of randomised trials Surgical patients from 25 countries | 2004 | Systematic review | n = 2,839 |
| Side-effects associated with ketamine use in depression: a systematic review. Patients with depression | 2018 | Systematic review |