• Robert J Rocchio and Kristina E Ward.
• Department of Pharmacy Practice, University of Rhode Island, Kingston, RI.
• Clin J Pain. 2021 Apr 1; 37 (4): 295300295-300.

ObjectivesThe aim was to review current evidence regarding the off-label use of intranasal ketamine for acute pain presenting in the setting of the emergency department, and secondary to pediatric limb injuries, renal colic, digital nerve block, and migraines.ResultsIn all 5 indications reviewed, ketamine demonstrated efficacy in reducing pain. However, when compared with other agents, ketamine did not demonstrate superiority over opioids in pediatric limb injuries or renal colic and was not as efficacious as standard therapy for migraine relief. Ketamine was also associated with a greater incidence of transient adverse reactions, such as dizziness, bitter aftertaste, fatigue, and vomiting than opioid therapies.DiscussionThe current body of evidence is insufficient to support the use of intranasal ketamine over other standard therapies for acute pain. However, current evidence can be used when developing dosing strategies, preparing for adverse reactions, and generating hypotheses for future, more robust research.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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