Efficacy Of Intravenous Ketamine as an Adjunct To Local Anesthesia in Pain Relief From Double Lumen Catheter Placement for Hemodialysis In The Emergency Department
DOI:
https://doi.org/10.51253/pafmj.v76i6.10124Keywords:
DLC catheter, Ketamine, Pain Relief, Procedural SedationAbstract
Objective: To compare the efficacy of intravenous Ketamine combined with local anesthesia for pain relief and procedural sedation for patients requiring DLC (double lumen catheter) insertion for urgent hemodialysis presenting in the emergency department.
Study design: Quasi-experimental study
Place and Duration of study: Accident and Emergency Department, Pak-Emirates Military Hospital, Rawalpindi, Pakistan, from Jan to Dec 2021.
Methodology: 110 patients were included in the study, divided into a Ketamine Group (n=55) and a Local Anesthetic Group (n=55). Primary variables measured were pain on the VAS at the time of needle prick, 15 and 30 minutes after the procedure, and changes in heart rate and mean arterial pressure at the time of needle prick, 15 and 30 minutes following the procedure.
Results: The mean visual analog scale for the Ketamine group at the time of prick and after 15 and 30-minutes post-procedure showed a marked improvement in response to pain versus the Lignocaine group (p<0.0001). The same statistically significant change was seen for both primary parameters, mean arterial pressure (MAP) as well as heart rate (p<0.0001). The difference between both groups was more marked at the time of prick and gradually decreased as time post-procedure increased. However, pain scale, MAP, and heart rate all remained significantly stable and better in the Ketamine group.
Conclusion: We conclude that Ketamine is an effective adjunct to local anesthesia for DLC insertion in the ER in ESKD patients, resulting in low pain scores, hemodynamic stability, and improved success of the procedure.
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References
1. Lv JC, Zhang LX. Prevalence and disease burden of chronic kidney disease. Adv Exp Med Biol 2019; 1165: 3-15.
https://doi.org/10.1007/978-981-13-8871-2_1
2. Tao S, Zeng X, Liu J, Fu P. Socioeconomic status and mortality among dialysis patients: a systematic review and meta-analysis. Int Urol Nephrol 2019; 51(3): 509-518.
https://doi.org/10.1007/s11255-019-02078-5
3. Gilardino RE, González-Pier E, Brabata C. End-stage renal disease models in the Americas: optimizing resources to achieve better health outcomes. Value Health Reg Issues 2018; 17: 115-118.
https://doi.org/10.1016/j.vhri.2018.04.001
4. Tandukar S, Palevsky PM. Continuous renal replacement therapy: who, when, why, and how. Chest 2019; 155(3): 626-638. https://doi.org/10.1016/j.chest.2018.09.004
5. Kocaaslan C, Kehlibar T, Yilmaz M, Mehmetoglu ME, Gunay R, Aldag M, et al. Outcomes of arteriovenous fistula for hemodialysis in octogenarian population. Vascular 2018; 26(5): 509-514.
https://doi.org/10.1177/1708538118762067
6. Troutman HR. Preparation for renal replacement therapy. In: Approaches to Chronic Kidney Disease. Cham: Springer; 2022: p. 411-423.
https://doi.org/10.1007/978-3-030-83082-3_23
7. Khan SU, Amir M, Javed A, Nisar S, Khan MNA, Javed MA. Comparison of frequency of infection between internal jugular and femoral vein double lumen hemodialysis catheter in chronic kidney disease (CKD) patients. Pak Armed Forces Med J 2021; 71(3): 993-995.
https://doi.org/10.51253/pafmj.v71i3.4079
8. Wiradana A, Wibawa I, Budiarta IB. Bloodstream infection of double lumen catheter among hemodialysis patients. J Ind Soc Vasc Endovasc Surg 2021; 2(1): 31-36.
https://doi.org/10.36864/jinasvs.2021.1.009
9. Wolf S. Educating Doctors: Crisis in Medical Education, Research & Practice. London: Routledge; 2018. p. 1-280.
https://doi.org/10.4324/9781351291651
10. Abdollahpour A, Saffarieh E, Zoroufchi BH. A review on the recent application of ketamine in the management of anesthesia, pain, and health care. J Family Med Prim Care 2020; 9(3): 1317-1324.
https://doi.org/10.4103/jfmpc.jfmpc_875_19
11. Estridge KM, Morris DL, Kolcaba K, Winkelman C. Comfort and fluid retention in adult patients receiving hemodialysis. Nephrol Nurs J 2018; 45(1): 25-33.
12. Combes G, Damery S, Sein K, Allen K, Nicholas J, Baharani J. Distress in patients with end-stage renal disease: staff perceptions of barriers to the identification of mild-moderate distress and the provision of emotional support. PLoS One 2019; 14(11): e0225269.
https://doi.org/10.1371/journal.pone.0225269
13. Sanchez AC, Scutt B, Burhoe DN. Ketamine for pain: the dosing dilemma and missing pieces. Pediatr Emerg Care 2021; 37(12): e1766-e1767.
https://doi.org/10.1097/PEC.0000000000002581
14. Davis WD, Davis KA, Hooper K. The use of ketamine for the management of acute pain in the emergency department. Adv Emerg Nurs J 2019; 41(2): 111-121.
https://doi.org/10.1097/TME.0000000000000238
15. Barrett W, Buxhoeveden M, Dhillon S. Ketamine: a versatile tool for anesthesia and analgesia. Curr Opin Anesthesiol 2020; 33(5): 633-638.
https://doi.org/10.1097/ACO.0000000000000916
16. Ghojazadeh M, Sanaie S, Paknezhad SP, Faghih SS, Soleimanpour H. Using ketamine and propofol for procedural sedation of adults in the emergency department: a systematic review and meta-analysis. Adv Pharm Bull 2019; 9(1): 5-15. https://doi.org/10.15171/apb.2019.002
17. Nichols KA, Paciullo CA. Subdissociative ketamine use in the emergency department. Adv Emerg Nurs J 2019; 41(1): 15-22. https://doi.org/10.1097/TME.0000000000000222
18. Gitlin J, Chamadia S, Locascio JJ, Ethridge BR, Pedemonte JC, Hahm EY, et al. Dissociative and analgesic properties of ketamine are independent. Anesthesiology 2020; 133(5): 1021-1028.
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Copyright (c) 2026 Syed Muhammad Hassan Kazmi, Muhammad Nadeem Ashraf, Sobia Mariam; Muhammad Moaz Tamur Sarwar; Hafiz Muhammad Muazzam, Hafiz Muhammad Azeem
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