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Intranasal equals subcutaneous ketamine for pain

Intranasal Versus Subcutaneous Ketamine for the Treatment of Acute Traumatic Pain in the Emergency Department: A Randomized Clinical Trial
Annals of Emergency Medicine · Added 20 August 2026

RCT testing whether intranasal ketamine is non-inferior to subcutaneous for acute traumatic pain — both routes provided equivalent analgesia with minimal clinically important differences, though minor adverse events were more common with subcutaneous administration.

Study type

RCT

Design

Randomised double-blinded double-dummy trial

Participants

1,194 adults (599 subcutaneous, 595 intranasal) with acute musculoskeletal trauma

Main finding

Mean NRS reduction at 30 min −4.42 (intranasal) vs −3.70 (subcutaneous), difference −0.72 (95% CI −0.95 to −0.48), below the 1.3 clinically important threshold; more minor adverse events with subcutaneous

Caveat

ED-based study of adults aged 18–65 using fixed 20 mg dose; prehospital relevance unclear

Bottom line

Supports current practice

Learning goal

Weigh the benefits and harms of intranasal versus subcutaneous ketamine for managing acute traumatic pain in my practice.

More

• Topic: Pain & sedation
• Daily scan: 20 August 2026

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