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<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE html> <html lang="en" dir="ltr" version="HTML+RDFa+MathML 1.1" xmlns:dc="http://purl.org/dc/terms/" xmlns:foaf="http://xmlns.com/foaf/0.1/" xmlns:og="http://ogp.me/ns#" xmlns:rdfs="http://www.w3.org/2000/01/rdf-schema#" xmlns:sioc="http://rdfs.org/sioc/ns#" xmlns:sioct="http://rdfs.org/sioc/types#" xmlns:skos="http://www.w3.org/2004/02/skos/core#" xmlns:xsd="http://www.w3.org/2001/XMLSchema#" xmlns:mml="http://www.w3.org/1998/Math/MathML"> <head profile="http://www.w3.org/1999/xhtml/vocab">  <meta http-equiv="Content-Type" content="text/html; charset=utf-8" /> <link rel="shortcut icon" href="https://bmjopen.bmj.com/sites/default/themes/bmjj/favicon.ico" type="image/vnd.microsoft.icon" /> <meta name="viewport" content="width=device-width, initial-scale=1" /> <meta name="citation_funding_source" content="citation_funder=Stiftelsen Norsk Luftambulanse;citation_funder_id=http://dx.doi.org/10.13039/501100013232;citation_grant_number=N/A;" /> <meta name="citation_funding_source" content="citation_funder=Scandinavian Society of Anaesthesiology and Intensive care medicine;citation_grant_number=N/A;" /> <meta name="type" content="article" /> <meta name="category" content="research-article" /> <meta name="HW.identifier" content="/bmjopen/10/11/e038134.atom" /> <meta name="HW.pisa" content="bmjopen;10/11/e038134" /> <meta name="DC.Format" content="text/html" /> <meta name="DC.Language" content="en" /> <meta name="DC.Title" content="Ketamine for the treatment of prehospital acute pain: a systematic review of benefit and harm" /> <meta name="DC.Identifier" content="10.1136/bmjopen-2020-038134" /> <meta name="DC.Date" content="2020-11-01" /> <meta name="DC.Publisher" content="British Medical Journal Publishing Group" /> <meta name="DC.Rights" content="© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/." /> <meta name="DC.AccessRights" content="open-access" /> <meta name="DC.Description" content="Background Few publications have addressed prehospital use of ketamine in analgesic doses. We aimed to assess the effect and safety profile of ketamine compared with other analgesic drugs (or no drug) in adult prehospital patients with acute pain. Methods A systematic review of clinical trials assessing prehospital administration of ketamine in analgesic doses compared with other analgesic drugs or no analgesic treatment in adults. We searched PubMed, EMBASE, Cochrane Library and Epistemonikos from inception until 15 February 2020, including relevant articles in English and Nordic languages. We used the Cochrane and Grading of Recommendations Assessment, Development and Evaluation methodologies and exclusively assessed patient-centred outcomes. Two independent authors screened trials for eligibility, extracted data and assessed risk of bias. Results We included eight studies (2760 patients). Ketamine was compared with various opioids given alone, and intranasal ketamine given with nitrous oxide was compared with nitrous oxide given alone. Four randomised controlled trials (RCTs) and one cluster randomised trial included 699 patients. One prospective cohort included 27 patients and two retrospective cohorts included 2034 patients. Five of the eight studies had high risks of bias. Pain score with ketamine is probably lower than after opioids as demonstrated in a cluster-RCT (308 patients) and a retrospective cohort (158 patients) study, Δ visual analogue scale −0.4 (−0.8 to 0.0) and Δ numeric pain rating scale −3.0 (−3.86 to −2.14), respectively. Ketamine probably leads to less nausea and vomiting (risk ratio (RR) 0.24 (0.11 to 0.52)) but more agitation (RR 7.81 (1.85 to 33)) than opioids. Conclusions This systematic literature review finds that ketamine probably reduces pain more than opioids and with less nausea and vomiting but higher risk of agitation. Risk of bias in included studies is high. Other Scandinavian society of anaesthesiology and intensive care medicine funded meetings and software. The Norwegian Air Ambulance Foundation funded publication. Otherwise this research received no grant from any agency in the public, commercial or not-for-profit sectors. PROSPERO registration number CRD42018114399." /> <meta name="DC.Contributor" content="Mårten Sandberg" /> <meta name="DC.Contributor" content="Per Kristian Hyldmo" /> <meta name="DC.Contributor" content="Poul Kongstad" /> <meta name="DC.Contributor" content="Kristian Dahl Friesgaard" /> <meta name="DC.Contributor" content="Lasse Raatiniemi" /> <meta name="DC.Contributor" content="Robert Larsen" /> <meta name="DC.Contributor" content="Vidar Magnusson" /> <meta name="DC.Contributor" content="Leif Rognås" /> <meta name="DC.Contributor" content="Jouni Kurola" /> <meta name="DC.Contributor" content="Marius Rehn" /> <meta name="DC.Contributor" content="Gunn Elisabeth Vist" /> <meta name="article:published_time" content="2020-11-01" /> <meta name="article:section" content="Emergency medicine" /> <meta name="citation_title" content="Ketamine for the treatment of prehospital acute pain: a systematic review of benefit and harm" /> <meta name="citation_abstract" lang="en" content="<h3>Background</h3> <p>Few publications have addressed prehospital use of ketamine in analgesic doses. We aimed to assess the effect and safety profile of ketamine compared with other analgesic drugs (or no drug) in adult prehospital patients with acute pain.</p><h3>Methods</h3> <p>A systematic review of clinical trials assessing prehospital administration of ketamine in analgesic doses compared with other analgesic drugs or no analgesic treatment in adults. We searched PubMed, EMBASE, Cochrane Library and Epistemonikos from inception until 15 February 2020, including relevant articles in English and Nordic languages. We used the Cochrane and Grading of Recommendations Assessment, Development and Evaluation methodologies and exclusively assessed patient-centred outcomes. Two independent authors screened trials for eligibility, extracted data and assessed risk of bias.</p><h3>Results</h3> <p>We included eight studies (2760 patients). Ketamine was compared with various opioids given alone, and intranasal ketamine given with nitrous oxide was compared with nitrous oxide given alone. Four randomised controlled trials (RCTs) and one cluster randomised trial included 699 patients. One prospective cohort included 27 patients and two retrospective cohorts included 2034 patients. Five of the eight studies had high risks of bias. Pain score with ketamine is probably lower than after opioids as demonstrated in a cluster-RCT (308 patients) and a retrospective cohort (158 patients) study, <b>Δ</b>visual analogue scale −0.4 (−0.8 to 0.0) and <b>Δ</b>numeric pain rating scale −3.0 (−3.86 to −2.14), respectively. Ketamine probably leads to less nausea and vomiting (risk ratio (RR) 0.24 (0.11 to 0.52)) but more agitation (RR 7.81 (1.85 to 33)) than opioids.</p><h3>Conclusions</h3> <p>This systematic literature review finds that ketamine probably reduces pain more than opioids and with less nausea and vomiting but higher risk of agitation. Risk of bias in included studies is high.</p><h3>Other</h3> <p>Scandinavian society of anaesthesiology and intensive care medicine funded meetings and software. The Norwegian Air Ambulance Foundation funded publication. Otherwise this research received no grant from any agency in the public, commercial or not-for-profit sectors.</p><h3>PROSPERO registration number</h3> <p>CRD42018114399.</p>" /> <meta name="citation_journal_title" content="BMJ Open" /> <meta name="citation_publisher" content="British Medical Journal Publishing Group" /> <meta name="citation_publication_date" content="2020/11/01" /> <meta name="citation_mjid" content="bmjopen;10/11/e038134" /> <meta name="citation_id" content="10/11/e038134" /> <meta name="citation_public_url" content="https://bmjopen.bmj.com/content/10/11/e038134" /> <meta name="citation_abstract_html_url" content="https://bmjopen.bmj.com/content/10/11/e038134.abstract" /> <meta name="citation_full_html_url" content="https://bmjopen.bmj.com/content/10/11/e038134.full" /> <meta name="citation_pdf_url" content="https://bmjopen.bmj.com/content/bmjopen/10/11/e038134.full.pdf" /> <meta name="citation_issn" content="2044-6055" /> <meta name="citation_issn" content="2044-6055" /> <meta name="citation_doi" content="10.1136/bmjopen-2020-038134" /> <meta name="citation_pmid" content="33234621" /> <meta name="citation_volume" content="10" /> <meta name="citation_issue" content="11" /> <meta name="citation_article_type" content="Research Article" /> <meta name="citation_section" content="Emergency medicine" /> <meta name="citation_firstpage" content="e038134" /> <meta name="citation_access" content="all" /> <meta name="citation_author" content="Mårten Sandberg" /> <meta name="citation_author_institution" content="Division of Prehospital Services, Air Ambulance Department" /> <meta name="citation_author_institution" content="Oslo University Hospital" /> <meta name="citation_author_institution" content="Faculty of Medicine" /> <meta name="citation_author_institution" content="University of Oslo" /> <meta name="citation_author" content="Per Kristian Hyldmo" /> <meta name="citation_author_institution" content="Faculty of Health Sciences" /> <meta 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content="Regional Hospital of Horsens" /> <meta name="citation_author" content="Lasse Raatiniemi" /> <meta name="citation_author_institution" content="Centre for Prehospital Emergency Care" /> <meta name="citation_author_institution" content="Oulu University Hospital" /> <meta name="citation_author_institution" content="Anaesthesia Research group, MRC" /> <meta name="citation_author_institution" content="Oulu University Hospital and University of Oulu" /> <meta name="citation_author_orcid" content="http://orcid.org/0000-0001-5537-9749" /> <meta name="citation_author" content="Robert Larsen" /> <meta name="citation_author_institution" content="Department of Anaesthesiology and Intensive Care" /> <meta name="citation_author_institution" content="Linköping University Hospital" /> <meta name="citation_author_institution" content="Department of Biomedical and Clinical Sciences" /> <meta name="citation_author_institution" content="Linköping University" /> <meta name="citation_author" content="Vidar Magnusson" /> <meta name="citation_author_institution" content="Landspitalinn University Hospital" /> <meta name="citation_author" content="Leif Rognås" /> <meta name="citation_author_institution" content="Danish Air Ambulance" /> <meta name="citation_author_institution" content="Department of Anaesthesiology" /> <meta name="citation_author_institution" content="Aarhus University Hospital" /> <meta name="citation_author_institution" content="Department of Clinical Medicine" /> <meta name="citation_author_institution" content="Aarhus University" /> <meta name="citation_author_orcid" content="http://orcid.org/0000-0002-2542-565X" /> <meta name="citation_author" content="Jouni Kurola" /> <meta name="citation_author_institution" content="Centre for Prehospital Emergency Medicine" /> <meta name="citation_author_institution" content="Kuopio University Hospital" /> <meta name="citation_author_institution" content="University of Eastern Finland" /> <meta name="citation_author" content="Marius Rehn" /> <meta name="citation_author_institution" content="Division of Prehospital Services, Air Ambulance Department" /> <meta name="citation_author_institution" content="Oslo University Hospital" /> <meta name="citation_author_institution" content="Faculty of Health Sciences" /> <meta name="citation_author_institution" content="University of Stavanger" /> <meta name="citation_author_institution" content="Department of Research" /> <meta name="citation_author_institution" content="Norwegian Air Ambulance Foundation" /> <meta name="citation_author_orcid" content="http://orcid.org/0000-0001-9519-241X" /> <meta name="citation_author" content="Gunn Elisabeth Vist" /> <meta name="citation_author_institution" content="Division for Health Services" /> <meta name="citation_author_institution" content="Norwegian Institute of Public Health" /> <meta name="citation_reference" content="citation_journal_title=Emerg Med J;citation_author=PA. 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Stoll;citation_title=A systematic review and meta-analysis of ketamine as an alternative to opioids for acute pain in the emergency department;citation_pages=1086-97;citation_volume=25;citation_year=2018;citation_pmid=http://www.n" /> <meta name="citation_fulltext_world_readable" content="" /> <meta name="twitter:title" content="Ketamine for the treatment of prehospital acute pain: a systematic review of benefit and harm" /> <meta name="twitter:card" content="summary_large_image" /> <meta name="twitter:image" content="https://bmjopen.bmj.com/pages/wp-content/uploads/sites/7/2019/07/bmjopen-default-cover.png" /> <meta name="twitter:description" content="Background Few publications have addressed prehospital use of ketamine in analgesic doses. We aimed to assess the effect and safety profile of ketamine compared with other analgesic drugs (or no drug) in adult prehospital patients with acute pain. Methods A systematic review of clinical trials assessing prehospital administration of ketamine in analgesic doses compared with other analgesic drugs or no analgesic treatment in adults. We searched PubMed, EMBASE, Cochrane Library and Epistemonikos from inception until 15 February 2020, including relevant articles in English and Nordic languages. We used the Cochrane and Grading of Recommendations Assessment, Development and Evaluation methodologies and exclusively assessed patient-centred outcomes. Two independent authors screened trials for eligibility, extracted data and assessed risk of bias. Results We included eight studies (2760 patients). Ketamine was compared with various opioids given alone, and intranasal ketamine given with nitrous oxide was compared with nitrous oxide given alone. Four randomised controlled trials (RCTs) and one cluster randomised trial included 699 patients. One prospective cohort included 27 patients and two retrospective cohorts included 2034 patients. Five of the eight studies had high risks of bias. Pain score with ketamine is probably lower than after opioids as demonstrated in a cluster-RCT (308 patients) and a retrospective cohort (158 patients) study, Δ visual analogue scale −0.4 (−0.8 to 0.0) and Δ numeric pain rating scale −3.0 (−3.86 to −2.14), respectively. Ketamine probably leads to less nausea and vomiting (risk ratio (RR) 0.24 (0.11 to 0.52)) but more agitation (RR 7.81 (1.85 to 33)) than opioids. Conclusions This systematic literature review finds that ketamine probably reduces pain more than opioids and with less nausea and vomiting but higher risk of agitation. Risk of bias in included studies is high. Other Scandinavian society of anaesthesiology and intensive care medicine funded meetings and software. The Norwegian Air Ambulance Foundation funded publication. Otherwise this research received no grant from any agency in the public, commercial or not-for-profit sectors. PROSPERO registration number CRD42018114399." /> <meta name="og-title" property="og:title" content="Ketamine for the treatment of prehospital acute pain: a systematic review of benefit and harm" /> <meta name="og-url" property="og:url" content="https://bmjopen.bmj.com/content/10/11/e038134" /> <meta name="og-site-name" property="og:site_name" content="BMJ Open" /> <meta name="og-description" property="og:description" content="Background Few publications have addressed prehospital use of ketamine in analgesic doses. We aimed to assess the effect and safety profile of ketamine compared with other analgesic drugs (or no drug) in adult prehospital patients with acute pain. Methods A systematic review of clinical trials assessing prehospital administration of ketamine in analgesic doses compared with other analgesic drugs or no analgesic treatment in adults. We searched PubMed, EMBASE, Cochrane Library and Epistemonikos from inception until 15 February 2020, including relevant articles in English and Nordic languages. We used the Cochrane and Grading of Recommendations Assessment, Development and Evaluation methodologies and exclusively assessed patient-centred outcomes. Two independent authors screened trials for eligibility, extracted data and assessed risk of bias. Results We included eight studies (2760 patients). Ketamine was compared with various opioids given alone, and intranasal ketamine given with nitrous oxide was compared with nitrous oxide given alone. Four randomised controlled trials (RCTs) and one cluster randomised trial included 699 patients. One prospective cohort included 27 patients and two retrospective cohorts included 2034 patients. Five of the eight studies had high risks of bias. Pain score with ketamine is probably lower than after opioids as demonstrated in a cluster-RCT (308 patients) and a retrospective cohort (158 patients) study, Δ visual analogue scale −0.4 (−0.8 to 0.0) and Δ numeric pain rating scale −3.0 (−3.86 to −2.14), respectively. Ketamine probably leads to less nausea and vomiting (risk ratio (RR) 0.24 (0.11 to 0.52)) but more agitation (RR 7.81 (1.85 to 33)) than opioids. Conclusions This systematic literature review finds that ketamine probably reduces pain more than opioids and with less nausea and vomiting but higher risk of agitation. Risk of bias in included studies is high. Other Scandinavian society of anaesthesiology and intensive care medicine funded meetings and software. The Norwegian Air Ambulance Foundation funded publication. Otherwise this research received no grant from any agency in the public, commercial or not-for-profit sectors. PROSPERO registration number CRD42018114399." /> <meta name="og-type" property="og:type" content="article" /> <meta name="og-image" property="og:image" content="https://bmjopen.bmj.com/pages/wp-content/uploads/sites/7/2019/07/bmjopen-default-cover.png" /> <script>window.dataLayer = window.dataLayer || [];window.dataLayer.push({"page":{"hwTitle":"Ketamine for the treatment of prehospital acute pain: a systematic review of benefit and harm","hwUrl":"https://bmjopen.bmj.com/content/10/11/e038134","hwPath":"/content/10/11/e038134.info","hwType":"journal page"},"user":{"hwMemberID":"","hwLoggedIntoInstitutionID":"","hwLoggedIntoInstitution":"","hwAccessUsageTerms":"guest","hwRegisteredUser":"no","hwHasFullTextAccess":"yes","hwEntitled":"no","mail":"e3b0c44298fc1c149afbf4c8996fb92427ae41e4649b934ca495991b7852b855"},"content":{"hwIssueDate":"2020-11-01","hwIssueDateTime":"2020-11-01 00:00:00","hwPublicationDate":"2020-11-24","hwPublicationDateTime":"2020-11-24 07:54:18","hwNlmArticleType":"research-article","hwDOI":"10.1136/bmjopen-2020-038134","hwAuthors":"M\u00e5rten Sandberg,Per Kristian Hyldmo,Poul Kongstad,Kristian Dahl Friesgaard,Lasse Raatiniemi,Robert Larsen,Vidar Magnusson,Leif Rogn\u00e5s,Jouni Kurola,Marius Rehn,Gunn Elisabeth Vist","hwContributors":"","hwIsEarlyRelease":"no","hwEissn":"2044-6055","hwPissn":"2044-6055","hwVolume":"10","hwIssue":"11","hwArticleType":"Emergency medicine","hwTabView":"info","hwViewType":"full","hwAccessType":"OpenAccess","hwOpenAccess":"yes","hwFreeAccess":"yes","hwTaxonomy":"Emergency medicine","hwCorpusCode":"bmjopen","hwType":"article","hwSubtitle":null,"hwOverline":null,"hwPisaId":"bmjopen;10/11/e038134","hwFirstPage":null,"hwLastPage":null,"hwIsLatestVersion":"yes","hwIsCurrentIssue":"no","hwIsOpenIssue":"no","hwHasFullText":"yes","hwHasPDF":"yes","hwParentTitle":"BMJ Open: 10 (11)","hwElectronicPubDate":"2020-11-24","hwElectronicPubDateTime":"2020-11-24 07:54:18"}}); 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pane-bmjj-contributors author-ids col-narrow-12" > <h3 class="pane-title">Authors</h3> <div class="pane-content"> <div class="field field-name-field-highwire-a-contributors field-type-text field-label-hidden"><div class="field-items"><div class="field-item even"><div class="highwire-list-wrapper"><div class="highwire-list"><ul class="highwire-contributors-list multiple-contrib"><li class="first odd"><span class="nlm-given-names">Mårten</span> <span class="nlm-surname">Sandberg</span> <span class="nlm-aff"><span class="nlm-institution" data-content-type="department" data-hwp-id="institution-1">Division of Prehospital Services, Air Ambulance Department</span>, <span class="nlm-institution" data-hwp-id="institution-2">Oslo University Hospital</span>, <span class="nlm-addr-line" data-content-type="city">Oslo</span>, <span class="nlm-country">Norway</span></span><span class="nlm-aff"><span class="nlm-institution" data-content-type="department" data-hwp-id="institution-3">Faculty of Medicine</span>, <span class="nlm-institution" data-hwp-id="institution-4">University of Oslo</span>, <span class="nlm-addr-line" data-content-type="city">Oslo</span>, <span class="nlm-country">Norway</span></span> <a href="/lookup/external-ref?access_num=Sandberg%20M&link_type=AUTHORSEARCH" target="_blank" class="authour-link" data-icon-position="" data-hide-link-title="0">PubMed articles</a><a href="/lookup/google-scholar?author%5B0%5D=%22author%3AM%C3%A5rten%20Sandberg%22&gs_type=author" target="_blank" class="authour-link" data-icon-position="" data-hide-link-title="0">Google scholar articles</a></li><li class="even"><span class="nlm-given-names">Per Kristian</span> <span class="nlm-surname">Hyldmo</span> <span class="nlm-aff"><span class="nlm-institution" data-content-type="department" data-hwp-id="institution-5">Faculty of Health Sciences</span>, <span class="nlm-institution" data-hwp-id="institution-6">University of Stavanger</span>, <span class="nlm-addr-line" data-content-type="city">Stavanger</span>, <span class="nlm-country">Norway</span></span><span class="nlm-aff"><span class="nlm-institution" data-content-type="department" data-hwp-id="institution-7">Department of Research</span>, <span class="nlm-institution" data-hwp-id="institution-8">Norwegian Air Ambulance Foundation</span>, <span class="nlm-addr-line" data-content-type="city">Oslo</span>, <span class="nlm-country">Norway</span></span><span class="nlm-aff"><span class="nlm-institution" data-content-type="department" data-hwp-id="institution-9">Trauma Unit</span>, <span class="nlm-institution" data-hwp-id="institution-10">Sørlandet Hospital</span>, <span class="nlm-addr-line" data-content-type="city">Kristiansand</span>, <span class="nlm-country">Norway</span></span> <a href="/lookup/external-ref?access_num=Hyldmo%20PK&link_type=AUTHORSEARCH" target="_blank" class="authour-link" data-icon-position="" data-hide-link-title="0">PubMed articles</a><a href="/lookup/google-scholar?author%5B0%5D=%22author%3APer%20Kristian%20Hyldmo%22&gs_type=author" target="_blank" class="authour-link" data-icon-position="" data-hide-link-title="0">Google scholar articles</a></li><li class="odd"><span class="nlm-given-names">Poul</span> <span class="nlm-surname">Kongstad</span> <span class="nlm-aff"><span class="nlm-institution" data-content-type="department" data-hwp-id="institution-11">Department of Prehospital Care and Disaster Medicine</span>, <span class="nlm-institution" data-hwp-id="institution-12">Region of Skåne</span>, <span class="nlm-addr-line" data-content-type="city">Lund</span>, <span class="nlm-country">Sweden</span></span> <a href="/lookup/external-ref?access_num=Kongstad%20P&link_type=AUTHORSEARCH" target="_blank" class="authour-link" data-icon-position="" data-hide-link-title="0">PubMed articles</a><a href="/lookup/google-scholar?author%5B0%5D=%22author%3APoul%20Kongstad%22&gs_type=author" target="_blank" class="authour-link" data-icon-position="" data-hide-link-title="0">Google scholar articles</a></li><li class="even"><span class="nlm-given-names">Kristian</span> <span class="nlm-surname">Dahl Friesgaard</span> <span class="nlm-aff"><span class="nlm-institution" data-content-type="department" data-hwp-id="institution-13">Research Department</span>, <span class="nlm-institution" data-hwp-id="institution-14">Prehospital Emergency Medical Service, Central Denmark Region</span>, <span class="nlm-addr-line" data-content-type="city">Aarhus</span>, <span class="nlm-country">Denmark</span></span><span class="nlm-aff"><span class="nlm-institution" data-content-type="department" data-hwp-id="institution-15">Department of Anaesthesiology</span>, <span class="nlm-institution" data-hwp-id="institution-16">Regional Hospital of Horsens</span>, <span class="nlm-addr-line" data-content-type="city">Horsens</span>, <span class="nlm-country">Denmark</span></span> <a href="/lookup/external-ref?access_num=Dahl%20Friesgaard%20K&link_type=AUTHORSEARCH" target="_blank" class="authour-link" data-icon-position="" data-hide-link-title="0">PubMed articles</a><a href="/lookup/google-scholar?author%5B0%5D=%22author%3AKristian%20Dahl%20Friesgaard%22&gs_type=author" target="_blank" class="authour-link" data-icon-position="" data-hide-link-title="0">Google scholar articles</a></li><li class="odd"><span class="nlm-given-names">Lasse</span> <span class="nlm-surname">Raatiniemi</span> <span class="nlm-aff"><span class="nlm-institution" data-content-type="department" data-hwp-id="institution-17">Centre for Prehospital Emergency Care</span>, <span class="nlm-institution" data-hwp-id="institution-18">Oulu University Hospital</span>, <span class="nlm-addr-line" data-content-type="city">Oulu</span>, <span class="nlm-country">Finland</span></span><span class="nlm-aff"><span class="nlm-institution" data-content-type="department" data-hwp-id="institution-19">Anaesthesia Research group, MRC</span>, <span class="nlm-institution" data-hwp-id="institution-20">Oulu University Hospital and University of Oulu</span>, <span class="nlm-addr-line" data-content-type="city">Oulu</span>, <span class="nlm-country">Finland</span></span> <span class="nlm-contrib-id" data-contrib-id-type="orcid" data-authenticated="false" data-href="http://orcid.org/0000-0001-5537-9749"></span><a href="/lookup/external-ref?access_num=Raatiniemi%20L&link_type=AUTHORSEARCH" target="_blank" class="authour-link" data-icon-position="" data-hide-link-title="0">PubMed articles</a><a href="/lookup/google-scholar?author%5B0%5D=%22author%3ALasse%20Raatiniemi%22&gs_type=author" target="_blank" class="authour-link" data-icon-position="" data-hide-link-title="0">Google scholar articles</a></li><li class="even"><span class="nlm-given-names">Robert</span> <span class="nlm-surname">Larsen</span> <span class="nlm-aff"><span class="nlm-institution" data-content-type="department" data-hwp-id="institution-21">Department of Anaesthesiology and Intensive Care</span>, <span class="nlm-institution" data-hwp-id="institution-22">Linköping University Hospital</span>, <span class="nlm-addr-line" data-content-type="city">Linköping</span>, <span class="nlm-country">Sweden</span></span><span class="nlm-aff"><span class="nlm-institution" data-content-type="department" data-hwp-id="institution-23">Department of Biomedical and Clinical Sciences</span>, <span class="nlm-institution" data-hwp-id="institution-24">Linköping University</span>, <span class="nlm-addr-line" data-content-type="city">Linköping</span>, <span class="nlm-country">Sweden</span></span> <a href="/lookup/external-ref?access_num=Larsen%20R&link_type=AUTHORSEARCH" target="_blank" class="authour-link" data-icon-position="" data-hide-link-title="0">PubMed articles</a><a href="/lookup/google-scholar?author%5B0%5D=%22author%3ARobert%20Larsen%22&gs_type=author" target="_blank" class="authour-link" data-icon-position="" data-hide-link-title="0">Google scholar articles</a></li><li class="odd"><span class="nlm-given-names">Vidar</span> <span class="nlm-surname">Magnusson</span> <span class="nlm-aff"><span class="nlm-institution" data-hwp-id="institution-25">Landspitalinn University Hospital</span>, <span class="nlm-addr-line" data-content-type="city">Reykjavik</span>, <span class="nlm-country">Iceland</span></span> <a href="/lookup/external-ref?access_num=Magnusson%20V&link_type=AUTHORSEARCH" target="_blank" class="authour-link" data-icon-position="" data-hide-link-title="0">PubMed articles</a><a href="/lookup/google-scholar?author%5B0%5D=%22author%3AVidar%20Magnusson%22&gs_type=author" target="_blank" class="authour-link" data-icon-position="" data-hide-link-title="0">Google scholar articles</a></li><li class="even"><span class="nlm-given-names">Leif</span> <span class="nlm-surname">Rognås</span> <span class="nlm-aff"><span class="nlm-institution" data-hwp-id="institution-26">Danish Air Ambulance</span>, <span class="nlm-addr-line" data-content-type="city">Aarhus</span>, <span class="nlm-country">Denmark</span></span><span class="nlm-aff"><span class="nlm-institution" data-content-type="department" data-hwp-id="institution-27">Department of Anaesthesiology</span>, <span class="nlm-institution" data-hwp-id="institution-28">Aarhus University Hospital</span>, <span class="nlm-addr-line" data-content-type="city">Aarhus</span>, <span class="nlm-country">Denmark</span></span><span class="nlm-aff"><span class="nlm-institution" data-content-type="department" data-hwp-id="institution-29">Department of Clinical Medicine</span>, <span class="nlm-institution" data-hwp-id="institution-30">Aarhus University</span>, <span class="nlm-addr-line" data-content-type="city">Aarhus</span>, <span class="nlm-country">Denmark</span></span> <span class="nlm-contrib-id" data-contrib-id-type="orcid" data-authenticated="false" data-href="http://orcid.org/0000-0002-2542-565X"></span><a href="/lookup/external-ref?access_num=Rogn%C3%A5s%20L&link_type=AUTHORSEARCH" target="_blank" class="authour-link" data-icon-position="" data-hide-link-title="0">PubMed articles</a><a href="/lookup/google-scholar?author%5B0%5D=%22author%3ALeif%20Rogn%C3%A5s%22&gs_type=author" target="_blank" class="authour-link" data-icon-position="" data-hide-link-title="0">Google scholar articles</a></li><li class="odd"><span class="nlm-given-names">Jouni</span> <span class="nlm-surname">Kurola</span> <span class="nlm-aff"><span class="nlm-institution" data-content-type="department" data-hwp-id="institution-31">Centre for Prehospital Emergency Medicine</span>, <span class="nlm-institution" data-hwp-id="institution-32">Kuopio University Hospital</span>, <span class="nlm-addr-line" data-content-type="city">Kuopio</span>, <span class="nlm-country">Finland</span></span><span class="nlm-aff"><span class="nlm-institution" data-hwp-id="institution-33">University of Eastern Finland</span>, <span class="nlm-addr-line" data-content-type="city">Kuopio</span>, <span class="nlm-country">Finland</span></span> <a href="/lookup/external-ref?access_num=Kurola%20J&link_type=AUTHORSEARCH" target="_blank" class="authour-link" data-icon-position="" data-hide-link-title="0">PubMed articles</a><a href="/lookup/google-scholar?author%5B0%5D=%22author%3AJouni%20Kurola%22&gs_type=author" target="_blank" class="authour-link" data-icon-position="" data-hide-link-title="0">Google scholar articles</a></li><li class="even"><span class="nlm-given-names">Marius</span> <span class="nlm-surname">Rehn</span> <span class="nlm-aff"><span class="nlm-institution" data-content-type="department" data-hwp-id="institution-1">Division of Prehospital Services, Air Ambulance Department</span>, <span class="nlm-institution" data-hwp-id="institution-2">Oslo University Hospital</span>, <span class="nlm-addr-line" data-content-type="city">Oslo</span>, <span class="nlm-country">Norway</span></span><span class="nlm-aff"><span class="nlm-institution" data-content-type="department" data-hwp-id="institution-5">Faculty of Health Sciences</span>, <span class="nlm-institution" data-hwp-id="institution-6">University of Stavanger</span>, <span class="nlm-addr-line" data-content-type="city">Stavanger</span>, <span class="nlm-country">Norway</span></span><span class="nlm-aff"><span class="nlm-institution" data-content-type="department" data-hwp-id="institution-7">Department of Research</span>, <span class="nlm-institution" data-hwp-id="institution-8">Norwegian Air Ambulance Foundation</span>, <span class="nlm-addr-line" data-content-type="city">Oslo</span>, <span class="nlm-country">Norway</span></span> <span class="nlm-contrib-id" data-contrib-id-type="orcid" data-authenticated="false" data-href="http://orcid.org/0000-0001-9519-241X"></span><a href="/lookup/external-ref?access_num=Rehn%20M&link_type=AUTHORSEARCH" target="_blank" class="authour-link" data-icon-position="" data-hide-link-title="0">PubMed articles</a><a href="/lookup/google-scholar?author%5B0%5D=%22author%3AMarius%20Rehn%22&gs_type=author" target="_blank" class="authour-link" data-icon-position="" data-hide-link-title="0">Google scholar articles</a></li><li class="last odd"><span class="nlm-given-names">Gunn Elisabeth</span> <span class="nlm-surname">Vist</span> <span class="nlm-aff"><span class="nlm-institution" data-content-type="department" data-hwp-id="institution-34">Division for Health Services</span>, <span class="nlm-institution" data-hwp-id="institution-35">Norwegian Institute of Public Health</span>, <span class="nlm-addr-line" data-content-type="city">Oslo</span>, <span class="nlm-country">Norway</span></span> <a href="/lookup/external-ref?access_num=Vist%20GE&link_type=AUTHORSEARCH" target="_blank" class="authour-link" data-icon-position="" data-hide-link-title="0">PubMed articles</a><a href="/lookup/google-scholar?author%5B0%5D=%22author%3AGunn%20Elisabeth%20Vist%22&gs_type=author" target="_blank" class="authour-link" data-icon-position="" data-hide-link-title="0">Google scholar articles</a></li></ul></div></div></div></div></div> </div> </div> </div> </div> </div> </div>  <div class="panel-row-wrapper clearfix"> <div class="content-wrapper"> <div class="panel-panel panel-region-content"> <div class="inside"><div class="panel-pane pane-highwire-markup bmjj-corresp" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><ol xmlns:xhtml="http://www.w3.org/1999/xhtml" class="corresp-list"><li class="corresp" id="corresp-1"><span class="corresp-label">Correspondence to</span> Dr Marius Rehn; <span class="em-link"><span class="em-addr">rehmar{at}snla.no</span></span></li></ol></div><a href="https://bmjopen.bmj.com/content/10/11/e038134.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-article-citation" > <h2 class="pane-title">Citation</h2> <div class="pane-content"> <div class="highwire-article-citation highwire-citation-type-highwire-article node192784--3" data-node-nid="192784" id="node-192784--41497183368" data-pisa="bmjopen;10/11/e038134" data-pisa-master="bmjopen;bmjopen-2020-038134" data-apath="/bmjopen/10/11/e038134.atom"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-v1-cp clearfix bmjj-article-citation"> <div class="highwire-cite-authors"><span class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-surname">Sandberg</span> M</span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-surname">Hyldmo</span> PK</span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-surname">Kongstad</span> P</span></span><span class="citation-et">, et al</span></div> <div class="highwire-cite-title">Ketamine for the treatment of prehospital acute pain: a systematic review of benefit and harm</div> <div class="highwire-cite-metadata bmjj-citation-metadata"><span class="highwire-cite-metadata-journal highwire-cite-metadata">BMJ Open </span><span class="highwire-cite-metadata-year highwire-cite-metadata">2020;</span><span class="highwire-cite-metadata-volume highwire-cite-metadata">10:</span><span class="highwire-cite-metadata-elocation-id highwire-cite-metadata">e038134. </span><span class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">doi:</span> 10.1136/bmjopen-2020-038134 </span></div> </div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-panels-mini pane-jnl-template-bmjj-art-pub-history" > <div class="pane-content"> <div class="panel-display highwire-1col-stacked-layout" id="mini-panel-jnl_template_bmjj_art_pub_history"> <div class="panel-row-wrapper clearfix"> <div class="content-wrapper"> <div class="panel-panel panel-region-content"> <div class="inside"><div class="panel-pane pane-highwire-publication-history" > <h2 class="pane-title">Publication history</h2> <div class="pane-content"> <div class="field field-name-field-highwire-publication-history field-type-text field-label-hidden"><div class="field-items"><div class="field-item even"><ul class="publication-history"><li>Received February 28, 2020</li><li>Revised September 19, 2020</li><li>Accepted October 30, 2020</li><li class="published"><span class="published-label">First published</span> November 24, 2020.</li></ul></div></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-pubdate bmjj-pub-date" > <div class="pane-content"> 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