Tsk tsk tsk such anger LOL.... If other things can give the same relief without giving the effects that I have seen, why use it? (genuine question there) Why isn't it more commonly used, if it's so great? Why isn't in the protocols for more EMS/ER systems? I'm not saying it's altogether bad, I'm just saying *I* don't want it (not that I would necessarily have a choice, if cback220 is looming over my unconscious self
) .
"Administration of S(+) ketamine for acute pain relief after trauma increased post-traumatic stress disorder symptoms at one year compared to racemic ketamine or an opioid."
The above quotes are from the International Association for the Study of Pain, 2007.
This is good! So I am going to take your points by point. By the way, no anger here- but lots of medical discussions start with a friendly "prove it", and that doesnt translate well on teh interwebs.
- Other things (like opiods) CANT give the same relief. While morphine and fentanyl can dull your pain a bit, we all have a story about how "we saw this one dude take 30mg morphine IV and still scream". All trauma drugs are not created equal, and ketamine works in a different way (on the NDMA receptor, for the super geeks). We should use it because it's better for trauma- it's side effects are increased respiration (to a threshold point), increased blood pressure (due to peripheral vasoconstriction), and dilation of the bronchioles (bigger tubes for air to get in).
-Well, first off I would say it's not better understood because it was used primarily for animals and children until the Brits put it into wide use in trauma in the 70/80's time frame. The two focus groups (dogs and kids) have a hard time articulating the efficacy of a drug, you know what I mean? It's not commonly used because pain management as a whole isnt commonly used in the EMS systems we have today. It's the same reason tourniquets arent commonly used to stop bleeders. In TCCC, the tourniquet is the first step for any red stuff- if you did that in the EMS world, holy shit look out. Paramedics with short transport times rarely need to pass pain meds, because they will be at the hospital soon, and they can avoid potential liability. Hell, most rides you dont even stick an IV. I am not encompassing all EMS systems, but I feel pretty confident in saying that without a major backlash. Short answer? We dont see it more because the EMS world has taken a long time to catch up to the combat medicine world for more than 10 years now. Well, that's one reason, but it's also another thread. I digress.
-I think if you were hurt, and I was treating you, I would give you ketamine and versed. Not because I own stock in those companies, but because I have seen it control pain better than almost every opiod out there, and if I need to do something hurtful to you to make you better, I want you taken care of. That's just me. But I would bet you thank me later.
And to address the PTSD study- look
here and
here. You'll find studies that directly refute the institute of pains study. As a matter of point, ketamine is one of the leading edge
treatments for PTSD now (
here is a link to that study). And one note on that study- finding that ketamine DID but racemic ketamine DIDNT lead to PTSD is spurious at best. Same compound (albeit a balanced L/R isomer balanced in the racemic), same effects, but a lower incidence of PTSD? I would call polite BS, but I will do my research.
