Ketamine for Pediatric Bone Reduction in Emergency Medicine: A Systematic Review and Meta-Analysis of Safety and Efficacy

Purpose of Review This review evaluates the safety and efficacy of ketamine, alone or in combination with other agents, for procedural sedation during fracture reduction in pediatric emergency settings. The goal is to provide clinicians with an updated synthesis of evidence to guide sedation strategies in this common clinical scenario.by synthesizing evidence on outcomes such as adverse events, sedation success, and recovery time. Recent Findings A systematic review and meta-analysis of studies published up to January 2025 showed that the overall adverse event rate associated with ketamine was 24% (95% CI: 16–32%). Ketamine monotherapy was linked with higher rates of vomiting (13%) and agitation (17%), while combination regimens reduced agitation but were associated with a higher rate of severe hallucinations (28%). Airway problems were uncommon, with hypoxia occurring in only 1–5% of cases and no reports of intubation. Fracture reduction success rates were 86% with monotherapy and 99% with combination techniques. Recovery profiles differed: ketamine monotherapy had longer sedation duration (42.6 min) but shorter recovery time (44.1 min), while combinations resulted in shorter sedation (19.7 min) and longer recovery (76.7 min). Redosing was needed in 25% of monotherapy cases. Summary Ketamine is a safe and effective option for procedural sedation in pediatric fracture reduction. While combination regimens enhance procedural success and reduce agitation, they are associated with longer recovery times and more severe hallucinations. Ketamine monotherapy offers a faster recovery but may require redosing. Clinicians should individualize sedation strategies based on patient characteristics and institutional capabilities. Further research is needed to optimize dosing regimens, explore multimodal combinations, and conduct direct comparisons with other sedative agents.