In adult patients presenting to ED with severe acute pain, is intranasal ketamine as effective as intravenous opiates for pain reduction?
Emergency medicine journal : EMJ – May 30, 2025
Source: PubMed
Summary
Pain relief in emergency departments is evolving beyond traditional needle-based treatments. Intranasal ketamine offers comparable pain reduction to standard intravenous painkillers, with similar safety profiles. Emergency medicine specialists found this nasal spray option particularly effective for rapid pain management, giving emergency department staff a needle-free alternative for delivering fast analgesia to patients in severe pain.
Abstract
This systematic review assessed whether intranasal (IN) ketamine is as effective as intravenous (IV) opiates for adults presenting to the ED with acute severe pain. EMBASE and Medline were searched, using relevant search terms, identifying four studies relevant to our three-part question. Key findings, as well as study weaknesses, were presented in a table. In summary, our results indicate that IN ketamine provides pain relief comparable to IV morphine in this patient cohort, with a similar side effect profile. However, the generalisability of these findings is limited owing to the lack of uniformity in study methodologies, short-term follow-up, broad exclusion criteria, sampling techniques and small sample sizes. Further studies regarding the role of IN ketamine in this setting would be worthwhile.