Pain control by Ketamine in Combat Situations: Considerations and Outcomes

Pain management is an important key point to surmount multi-injured peoples in an overcrowding emergency setting. Its role would be more apparent when the physician encounters a mass casualty in a war zone or even a military prehospital. Proper pain management could prevent a hypercatabolic state and subsequent shock in an injured patient. Having sedative and analgesic properties, rapid onset and offset effects, maintaining the cardiovascular and respiratory contain are the main reason for the selection of ketamine as a good choice in the war zone.

In a prospective interventional study in a war zone, we have selected and followed two groups of casualties for pain management. All were men with an average age of 26.6+8 y/o and 27.5 +7 y/o at groups A and B respectively. Group A received only Ketamine and Group B, received ketamine and diazepam, too.

This study showed that all of the injured patients who received ketamine have experienced some degrees of agitation and they may finally need benzodiazepines for sedation but at group B that received benzodiazepine before or concomitant with ketamine, the agitation significantly reduced. (P-Value 50.05)

Various factors may affect pain score and pain perception; patient's culture, mental health, previous drug usage, and addiction could alter the pain score in similar situations. It seems that the significant agitation is due to catecholamine release in the rough situation of the war zone that is exacerbated with the ketamine properties, nonetheless, as a good choice, ketamine is now recommended to use with benzodiazepines in the critical condition such as war zone for procedural sedation and analgesia.