Intranasal ketamine causes more minor side effects, such as dizziness, than intranasal fentanyl used as analgesia for children with assumed single-extremity fractures, according to researchers.
The double-blind, randomized controlled trial (Acad Emerg Med 2017 Sep 19. [Epub ahead of print], doi:10.1111/acem.13313) in 82 children found that while pain relief was similar at 20 minutes between the two groups, the cumulative number of side effects in the ketamine group (n=41) was 2.2 times higher than in the fentanyl group (n=41). The patients had a median age of 8 years, and they were randomly assigned to receive one of the drugs. All of the ketamine patients and 61% of the fentanyl patients reported adverse events (risk difference, 39%; 95% CI, 24%-54%).
The most common adverse events with ketamine were bad taste in the mouth (37; 90%), dizziness (30; 73%) and sleepiness (19; 46%). With fentanyl, the most common side effects were sleepiness (15; 37%) and bad taste in the mouth (nine cases; 22%). The researchers also reported that the mean pain score reduction after 60 minutes was 42±32 for ketamine and 44±28 for fentanyl (mean difference, –2; 95% CI, –16 to 13).
“There is less information about ketamine available than is needed to determine its role as first-line pain therapy in children,” said James R. Miner, MD, FACEP, chief of emergency medicine at the Hennepin County Medical Center and professor of emergency medicine at the University of Minnesota, both in Minneapolis. “This study starts to give us the information necessary to determine ketamine’s place as a pain medication and its potential to replace opioids.”