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2015 ; 3
(2
): 59-63
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A Randomized Clinical Trial of Intravenous and Intramuscular Ketamine for
Pediatric Procedural Sedation and Analgesia
#MMPMID26495383
Gharavifard M
; Boroumand Reza Zadeh B
; Zamani Moghadam H
Emerg (Tehran)
2015[Spr]; 3
(2
): 59-63
PMID26495383
show ga
INTRODUCTION: Ketamine is an agent broadly used for pediatric procedural sedation
and analgesia in emergency departments. It has been found to be safe and with a
low risk of complications. Choosing between intravenous (IV) and intramuscular
(IM) injections is a matter of concern, so we did a comparison between the two
methods in terms of their efficacy and rate of complications. METHODS: This
single-blind clinical trial recruited 240 children (age: three months to 15
years, weight > 5 kg), who underwent short and painful procedures at the
emergency departments. They were randomly allocated to two groups of 120 patients
to receive either IV or IM ketamine with of 1.5 and 4 mg/kg doses, respectively.
Indications for use, dose, side effects, and efficacy of the medications as well
as duration of the procedure and time to recovery were compared between the two
groups. RESULTS: The mean age of the IV and IM groups were 6.5 ± 3.6 and 3.05 ±
2.6 years, respectively (p < 0.001). The onset of action of ketamine was 1.7 ±
1.1 minutes in the IV group and 8.6 ± 3.1 in the IM ones (p < 0.001). Patients of
the IV and IM groups remained in optimal sedation for 20.6±12.0 and 37.2±11.8
minutes, respectively (P < 0.001). Time until emergency department discharge was
65.3 ± 36.9 minutes in the IV group and 72.2 ± 14.5 in the IM group (P = 0.40).
Ketamine had excellent and moderate efficacy in 66.7% and 32.5% of the IV group
and 70.0% and 25.0% in the IM group, respectively (p = 0.02). Totally, 60.0% of
IV group patients and 40.0% of IM group experienced drug side effects (p = 0.21).
Need for rescue dose was significantly higher in IV group (26.7% vs. 10.0%; p <
0.001). Finally, recovery was tranquil and comfortable in 88 patients (73.3%) of
the IV group and 108 patients (90.0%) of the IM group (p = 0.06). CONCLUSION: We
found that although the sedative and analgesic effects of IM and IV ketamine are
not significantly different, duration of effect and onset of action are more
desirable in the IV group for suturing, fracture reduction, and foreign body
removal. Meanwhile, the IM method can lead to lesser need of rescue doses.