Subdissociative Dose Ketamine in Older Adults? – Maybe
With Dr. Sergey Motov
IV subdissociative dose ketamine (SDK) is used with increasing frequency for acute pain management in the ED. However, most studies have excluded older adults in assessing its efficacy and safety. In this episode, Sergey Motov (@painfreeED) discusses his recent paper “Intravenous subdissociative-dose ketamine versus morphine for acute geriatric pain in the Emergency Department: A randomized controlled trial” published in the American Journal of Emergency Medicine in May 2018.
This study enrolled patients age 65 and over and compared ketamine 0.3mg/kg over 15min vs morphine 0.1mg/kg over 15min for reduction of acute pain. Ketamine provided better improvement in pain at 15min, and similar pain improvement compared to morphine at 30min. However, there were significantly more side effects in the ketamine group, including dizziness, feeling of unreality, and hallucinations.
Future studies will focus on trying lower doses over longer infusion times to potentially reduce the side effects.
- Motov S, Mann S, Drapkin J, et al. Intravenous subdissociative-dose ketamine versus morphine for acute geriatric pain in the Emergency Department: A randomized controlled trial. Am J Emerg Med. May 2018. https://www.ncbi.nlm.nih.gov/pubmed/29807629
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This podcast uses sounds by Jobro and HerbertBoland
Dr. Christina Shenvi is an associate professor of Emergency Medicine at the University of North Carolina. She is fellowship-trained in Geriatric Emergency Medicine and is the founder of GEMCast. She is the director of the UNC Office of Academic Excellence, president of the Association of Professional Women in Medical Sciences, co-directs the ACEP/CORD Teaching Fellowship, is on the Annals of EM editorial board, is on the Geriatric ED Accreditation board of governors, and she teaches and writes about time management at timeforyourlife.org.