Comprehensive Summary
This randomized, placebo-controlled trial evaluated whether intranasal ketamine, when combined with fentanyl, improves analgesia for acute traumatic pain in prehospital care. Adult trauma patients requiring prehospital analgesia were enrolled. Participants were randomized to fentanyl plus placebo or fentanyl plus 50 mg of intranasal ketamine. Although more patients in the ketamine group achieved pain reduction at 30 minutes, the difference compared with fentanyl alone was not statistically significant. Adverse effects, including dizziness and mild dissociation, occurred more often with ketamine but were generally mild and well-tolerated. Overall, intranasal ketamine was safe and feasible in the prehospital setting, but it did not demonstrate a significant analgesic advantage over fentanyl alone.
Outcomes and Implications
This study highlights the challenge of optimizing acute pain management in trauma patients, particularly in resource-limited prehospital settings. Intranasal ketamine represents a noninvasive, rapid adjunct under investigation to supplement opioid-based pain control. If shown to be effective in future studies, this approach may reduce opioid requirements and related complications. For emergency medical services, this trial demonstrates that intranasal ketamine is a feasible and safe intervention in the field, though without proven additional analgesic benefit. Further studies are needed before intranasal ketamine can be integrated into prehospital protocols, as this trial did not demonstrate a clear analgesic benefit.