Intranasal ketamine versus intravenous opioids for acute pain in the emergency department: A scoping review.
The American journal of emergency medicine · 2026-06-02 · Scoping review
Abstract
INTRODUCTION: The need for alternative analgesia to opioids in the emergency department (ED) has become increasingly urgent due to the opioid epidemic. Ketamine, traditionally used for sedation, has emerged as a promising alternative for pain control in the acute care setting. This scoping review evaluates the use of intranasal (IN) ketamine compared with intravenous (IV) opioids for analgesic efficacy in treating acute pain in the ED. METHODS: A search of PubMed, CINAHL and PRIMO databases was conducted for randomized controlled trials (RCTs) published between 2015 and 2025. A total of 561 records were identified, and 8 RCTs evaluating analgesic efficacy as the primary outcome were included in this review. This review was conducted in accordance with the PRISMA-ScR reporting guidelines. RESULTS: Eight RCTs including 846 patients were included (2016-2025), all conducted in Iran, Israel, or Thailand. IN ketamine (0.3-1.5 mg/kg) was most commonly compared with IV morphine (0.1 mg/kg). Across studies, IN ketamine demonstrated comparable reductions in pain scores to IV morphine, with several trials reporting no statistically significant differences at measured time points, although IV morphine was generally associated with faster onset of analgesia. In one study, IV fentanyl produced greater pain reduction than IN ketamine. Adverse effects were generally mild and transient with IN ketamine associated with fewer adverse events compared to IV morphine. CONCLUSION: IN ketamine may be useful for acute pain management in the ED. However, further research is needed to determine optimal dosing, compare its efficacy with more potent opioids, and evaluate long-term outcomes associated with its use.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Anaesthetics · Analgesics · Fentanyl · Intranasal administration · Ketamine · Morphine
Related articles
- Intranasal ketamine versus intravenous opioids for renal colic pain in the emergency department: a systematic review and meta-analysis. (Eur J Emerg Med, 2026)
- Evidence-Based Guidelines for Prehospital Pain Management: Recommendations. (Prehosp Emerg Care, 2023)
- Intranasal analgesia for prehospital management of children in pain (Journal of Paramedic Practice, 2025)
- The effectiveness and safety of paediatric prehospital pain management: a systematic review. (Scand J Trauma Resusc Emerg Med, 2021)
- What is the Evidence for Using Intranasal Medicine in the Prehospital Setting? A Systematic Review. (Prehosp Emerg Care, 2024)
- Efficacy and safety of ketamine for pain in prehospital adult trauma: a review (Journal of Paramedic Practice, 2026)