Comparison of Adverse Events and Satisfaction between IV and IM Routes for Ketamine Sedation in Pediatric Facial Laceration Repair in the Emergency Department

ABSTRACT

PURPOSE: The purpose of this study is to compare adverse events and satisfaction of physician, nurse, and parent with intravenous (IV) versus intramuscular (IM) ketamine procedural sedation and analgesia for repair of pediatric facial laceration in the emergency department (ED). METHODS: Pediatric patients aged 1~5 years receiving ketamine for repair of facial laceration were enrolled in a prospective, randomized, controlled trial in the ED. All patients were initially randomized to receive ketamine either 2 mg/kg IV or 4 mg/kg IM. In this study, the primary outcomes were adverse events and length of sedation. The secondary outcomes were satisfaction of physician, nurse, and parent. RESULTS: A total of 78 patients were randomized (39 IV group, 39 IM group), and 76 patients, aged 1 to 5 years, completed the study; 37 IV group and 39 IM group. Vomiting in the ED was more common in the IM group (20.5% versus 2.7%; OR 9.29; 95% CI 1.1 to 78.46). Groan in the ED was less common in the IM group (10.3% versus 35.1%; OR 0.21; 95% CI 0.06 to 0.73). Other adverse events were similar between groups. The number of sedations attempted was higher in the IV group (mean 1.11 versus 1; p=.036). Length of sedation was significantly longer in the IM group (median 59 versus 27 minutes; p=.000). Satisfaction of physician and nurse was higher in the IM group (median 4 versus 4; p=.005 in physicians, 4 versus 2; p=.000 in nurses, Mann Whitney U test). Satisfaction of parent was similar between groups. CONCLUSION: In this study of ketamine sedation for repair of pediatric facial laceration, we found that ketamine 4 mg/kg IM was more effective than 2 mg/kg IV in providing adequate sedation and higher satisfaction of physician and nurse.