Alternatives to Opioids in ED Pain Management: Ketamine and IV Lidocaine
This month JC is going to look at a few alternative approaches to pain management in ED patients with acute pain syndromes. The CDCand others, have reported on the increase in opioid related deaths and there is clear evidence of what has been described as a “national epidemic.” For example, the CDC reports age-adjusted rate of drug overdose deaths increased from 6.1 per 100,000 standard population in 1999 to 16.3 in 2015, an overall average increase of 5.5% per year. There have been a host of initiatives such as the AAEM white paper, ALTO (alternative to opioid) programs, prescription monitoring programs and even legislation (ALTO bill) introduced by Sen. Cory Booker that received bipartisan support to provide resources to ED’s to assist in mitigating the opioid crisis. Dr. Sergi Motov has publishedextensively on the use of alternatives such as ketamine and lidocaine and was interviewed on EmCrit regarding the opioid-free ED. Though that may be a stretch for most, we will look as some of the more widely cited data on these alternative agents, share some experiences using them and hopefully, provide some guidance on the appropriate use of these adjuncts.