UMEM Educational Pearls

Category: Pediatrics

Title: Ketamine vs opiates for pediatric pain management

Keywords: Ketamine, morphine, fentanyl, pediatrics, EMS, pain control (PubMed Search)

Posted: 4/21/2023 by Jenny Guyther, MD (Updated: 4/24/2024)
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Multiple modalities are available for pain control in the pediatric setting.  Ketamine has recently been introduced into the prehospital environment as an alternative to opiates (fentanyl and morphine).  This study examines how ketamine and opiates compare in relation to pain reduction and adverse events.
9223 patients (< 18 years) were included with data from the ESO Collaborative. 190 patients received ketamine (2.1%) and 9033 received opiates (97.9%).  Ketamine was associated with a greater reduction in pain score (-4.4 vs -3.1) compared to opiates and a greater reduction in EMS clinician reported improvement.  Patients in the ketamine group did have a reduction in the GCS by -0.3 points.  There were no patients who required ventilatory support in the ketamine group and one patient who required support in the opiate group. No patients in either group required intubation or died.  This study did not examine medication doses or route.
Bottom line: Both ketamine and opiates are viable pain control options for pediatric patients in the prehospital environment.

References

Frawley J, Goyal A, Gappy R, et al. A Comparison of Prehospital Pediatric Analgesic Use of Ketamine and Opioids [published online ahead of print, 2023 Mar 8]. Prehosp Emerg Care. 2023;1-5. doi:10.1080/10903127.2023.2183295