Ketamine alleviates acute pain during ambulance rides

Dr Gary Andolfatto believes that primary care paramedics in BC should be permitted to administer ketamine.

In December 2015 Dr Gary Andolfatto had a biking accident, broke his femur, and dragged himself for almost 4 hours until he found a park ranger who called an ambulance. In a great deal of pain, the emergency physician was shocked to find that nitrous oxide was the only option. The attending primary care paramedic was frustrated too, explaining that it was particularly difficult during hours-long transports in rural areas.

Dr Andolfatto, a clinical assistant professor in the Department of Emergency Medicine in the UBC Faculty of Medicine and researcher with the Vancouver Coastal Health Research Institute, embarked on a research study to find a solution. His findings were published recently in the Annals of Emergency Medicine. In the study, Dr Andolfatto and his colleagues found that when ketamine is added to nitrous oxide and administered as a nose spray, it provides clinically significant pain reduction and improved comfort.

Between November 2017 and May 2018, 120 patients suffering with acute pain were given nitrous oxide, per existing paramedic protocols. Half of the 120 patients also randomly received intranasal ketamine and half received the placebo, a saline solution. Neither the paramedic nor the patient was told which had been administered. Individuals who received ketamine along with the nitrous oxide experienced a clinically significant reduction in pain at 15 minutes and 30 minutes after administration. Comfort was most pronounced at 15 minutes. While the majority of patients reported mild dizziness and a feeling of unreality, their levels of satisfaction were higher than those who received the placebo.

Dr Andolfatto wants to see primary care paramedics throughout the province permitted to use ketamine, a controlled substance. Advanced and critical care paramedics have more training and therefore more pain-alleviating options, including the use of ketamine, but of the more than 4000 paramedics in BC, 70% are primary care paramedics.

Ketamine is the most commonly used anesthetic worldwide because it doesn’t hamper breathing. It has previously gained notoriety for being an animal tranquilizer popular with ravers. “With low-dose ketamine, says Dr Andolfatto, “there is no risk of serious harm, the technology is simple and cheap, and the level of training is negligible. There are many reasons why it makes sense for this to be used more widely in an ambulance setting.”