Pain Free Laceration Repairs Using Intra-nasal Ketamine
Status:
Completed
Trial end date:
2019-11-27
Target enrollment:
Participant gender:
Summary
Lacerations are one of most common trauma in children presenting to the emergency department
(ED). Currently, there are wide variations regarding sedation and analgesia practices when
suture are required. Even though topical anesthesia is very useful to reduce pain, it does
not obviate the use of pharmacologic agents to decrease stress in anxious children undergoing
laceration repairs in the ED.
There is a growing interest in the intranasal (IN) route of administration in the pediatric
population. It bypasses the first hepatic passage and thus provides medications direct access
to the systemic circulation leading to higher and faster serum concentrations than would the
oral route. Also, intravenous (IV) cannulation can be avoided reducing the pain associated
with it and the need for nursing time and procedure delay. IN fentanyl and midazolam are two
agents that can be combined for this procedure, but respiratory depression is a feared
adverse effects. Ketamine is the most commonly used IV agent for procedural sedation, and can
offer potent analgesia and sedation while maintaining respiratory drive and protective airway
reflexes. Few studies have evaluated IN ketamine for procedural sedation. There is a wide
range of dosing reported from 3 to 9 mg/kg. This raises the question as what is the lowest
possible dosage that can be used to successfully repairs laceration in children with minimal
restrain and no adverse events, as described by the Pediatric Emergency Research Canada
(PERC)/ Pediatric Emergency Care Applied Research Network (PECARN) consensus.