Efficacy Of Intravenous Ketamine as an Adjunct To Local Anesthesia in Pain Relief From Double Lumen Catheter Placement for Hemodialysis In The Emergency Department

Objective: To compare the efficacy of intravenous Ketamine combined with local anesthesia for pain relief and procedural sedation for patients requiring DLC (double lumen catheter) insertion for urgent hemodialysis presenting in the emergency department. Study design: Quasi-experimental study Place and Duration of study: Accident and Emergency Department, Pak-Emirates Military Hospital, Rawalpindi, Pakistan, from Jan to Dec 2021. Methodology: 110 patients were included in the study, divided into a Ketamine Group (n=55) and a Local Anesthetic Group (n=55). Primary variables measured were pain on the VAS at the time of needle prick, 15 and 30 minutes after the procedure, and changes in heart rate and mean arterial pressure at the time of needle prick, 15 and 30 minutes following the procedure. Results: The mean visual analog scale for the Ketamine group at the time of prick and after 15 and 30-minutes post-procedure showed a marked improvement in response to pain versus the Lignocaine group (p<0.0001). The same statistically significant change was seen for both primary parameters, mean arterial pressure (MAP) as well as heart rate (p<0.0001). The difference between both groups was more marked at the time of prick and gradually decreased as time post-procedure increased. However, pain scale, MAP, and heart rate all remained significantly stable and better in the Ketamine group. Conclusion: We conclude that Ketamine is an effective adjunct to local anesthesia for DLC insertion in the ER in ESKD patients, resulting in low pain scores, hemodynamic stability, and improved success of the procedure.