Efficacy of Low-dose Ketamine for Control of Acute Pain in the Emergency Setting: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Introduction: Ketamine can be particularly helpful in situations where the clinician is not able to administer opioids and require an alternate analgesic, such as for patients who are already on high-dose opioids, have a history of addiction, or opioid-naïve children adults. In this review, our goal was obtain comprehensive estimate efficacy safety low-dose ketamine (dose less than 0.5 milligrams per kilogram equivalent) compared opiates control acute pain emergency setting.Methods: We conducted systematic searches PubMed Central, EMBASE, MEDLINE, Cochrane Library, ScienceDirect, Google Scholar from inception until November 2021. used risk-of-bias tool assess quality included studies.Results: carried out meta-analysis with random-effects model reported pooled standardized mean difference (SMD) risk ratio (RR) 95% confidence intervals depending type outcome. analyzed total 15 studies 1,613 participants. Half them had high bias were United States America. The SMD score -0.12 (95% CI -0.50-0.25; I2=68.8%) within minutes, -0.45 -0.84- -0.07; I2=83.3%) 30 -0.05 -0.41-0.31; I2=86.9%) 45 -0.07 -0.41-0.26; I2=82%) 60 after minutes 0.17 -0.07-0.42; I2=64.8%). RR need rescue analgesics 1.35 0.73-2.50; I2=82.2%). RRs follows: 1.18 0.76-1.84; I2=28.3%) gastrointestinal side effects; 1.41 0.96-2.06; I2=29.7%) neurological 2.83 0.98-8.18; I2=47%) psychological 0.58 0.23-1.48; I2=36.1%) cardiopulmonary effects.Conclusion: Low-dose might higher equivalent when managing among presenting setting. However, further required establish conclusive evidence, owing heterogeneity poor existing studies.