2026 Southeastern Residency Conference

Title: Analgesic Dose Ketamine Infusion for Pain Control of Trauma Patients in the Critical Care Setting

Authors: Alyssa Sangalang, Brooke Gallman, & Jamie McCarthy

Practice Site: Piedmont Athens Regional Medical Center

Introduction: Adequate pain control is essential in the management of traumatic injuries. Per the 2018 Society of Critical Care Medicine Pain, Agitation/Sedation, Delirium, Immobility, Sleep Guidelines and the 2024 American College of Surgeons Trauma Quality Improvement Programs Best Practice Guidelines, opioids remain as the standard treatment approach with trauma induced pain. However, because of the deleterious effects of opioids, such as hypotension, hypoxia, decreased gastrointestinal motility, and tolerance, these guidelines recommend a multimodal analgesic approach for sparing opioids and therefore, avoiding unwanted side effects. Ketamine is a N-methyl-D-aspartate receptor antagonist that has analgesic properties at low doses (<0.5 mg/kg/hr) and is a component of the multimodal approach. Ketamine usage at Piedmont Athens Regional (PAR) has previously been utilized for pain as single dose, push orders. Additionally, ketamine use has been ordered at higher, titratable doses for indications such as sedation and agitation. At higher doses, ketamine requires patient monitoring due to the potential risk of cardiovascular, respiratory, and psychiatric events. The analgesic dose ketamine infusion could be a favorable option because it provides analgesia while reducing these potential risks. The primary objective of this study was to determine if the intervention of analgesic dose ketamine infusion would be a safe and effective adjunct therapy to opioids for pain control in trauma patients.

Methods: This single-center, IRB-exempt, pre-post interventional study was completed via a chart review. The intervention investigated was a low, analgesic dose ketamine infusion for pain control in patients admitted due to trauma. The pre-intervention group included patients from October 1st, 2024, to February 28th, 2025, who would have met criteria to receive an adjunct analgesic dose ketamine infusion for pain control if the guidance had been readily available. Patients admitted during this pre-specified period were randomized and data collected on the number of patients necessary to match the post-intervention group.  The inclusion criteria included age greater than 18 years and admission to ICU for a trauma event. The exclusion criteria included pregnancy and contraindications to ketamine. The post-intervention group included patients admitted from October 1st, 2025, to February 28th, 2026. The primary outcome was oral morphine milligram equivalents (MME) per day between the pre- and post-intervention groups. Secondary outcomes were numeric rating pain scores, other multimodal pain modalities received, lengths of stay, oral MME at discharge, and adverse events related to ketamine.   Data between the two groups was analyzed with Microsoft Excel. Chi-square tests were utilized for categorical data and reported as number and percentage. Paired and unpaired t-Test and two-way ANOVA were used for continuous parametric data and reported as mean and standard deviation as appropriate. Outcomes were considered statistically significant if the p-value is ≤ 0.05.

Results: Seven patients were included in the pre- and post-intervention groups. For the primary outcome, the pre-intervention group had an average of 54 oral MME per day compared to 44 oral MME in the post-intervention group (p = 0.26). There was no difference in pain scores between groups over time (p = 0.61) or MME at discharge (p = 0.087). There was a reduction in pain scores prior to and 24 hours after ketamine initiation (p = 0.006). No difference in heart rate or mean arterial pressure was detected between groups (p = 0.22 and p = 0.08). No adverse events were reported in the post-intervention group due to ketamine.

Discussion: A low, analgesic dose ketamine infusion did not detect a difference in oral MME in this small cohort. However, ketamine reduced pain at 24 hours and appeared to be a safe adjunct to opioids.