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Aspirin and Ketamine Combination for Pain Management

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The combination therapy of Aspirin and Ketamine has been proven effective in pain management in emergency medicine. Read this article to learn more.

Medically reviewed by

Dr. Kaushal Bhavsar

Published At May 23, 2023
Reviewed AtJune 20, 2023

Introduction

For a study, researchers wanted to find out how well Aspirin and Ketamine work together to relieve pain in adults with acute musculoskeletal pain (MSK) in the emergency department (ED).

It was a single-arm, prospective, proof-of-concept pilot trial that looked at how well a single dose of Aspirin plus Ketamine relieved acute moderate-to-severe MSK pain in adults who went to the ED. At 60 minutes, the most important result was the difference between the pain ratings on an 11-point scale. Secondary outcomes included the need for rescue analgesia, adverse events at 60 minutes, and a change in pain levels at 120 minutes.

There were 25 people in the study. At the start, the average pain score was 8.6; after 60 minutes, it was 4.8. Oral doses of Ketamine ranged from 24 mg to 50 mg, with 37.8 mg being the average. There were no changes in vital signs that were clinically important. There were no significant problems with any of the people. Most of the bad things that happened were short-term and not very bad.

They found that when adults with acute MSK pain were given a combination of Aspirin and Ketamine by mouth, 80 % of them had a clinically significant decrease in pain.

What Is Aspirin?

Aspirin is a type of nonsteroidal anti-inflammatory medication (NSAID). It was the first of its kind to be discovered. Salicylate is a chemical found in plants such as the willow tree and myrtle. Its use was initially documented approximately 4,000 years ago. Hippocrates used willow bark to treat pain and fevers, and some people still use it as a natural cure for headaches and moderate pain. NSAIDs are a type of medication that has the following effects:

  • Reducing pain.

  • In higher doses, it reduces fever and inflammation.

What Is Ketamine?

Ketamine, often known as Ketalar, is a dissociative anesthetic. Doctors use it to induce general anesthesia. A reliable source for medical operations that do not necessitate muscular relaxation. General anesthesia refers to a sleep-like state, whereas dissociation relates to the sensation of being separated. The FDA only licenses Ketamine for general anesthesia. However, it has specific off-label uses also.

  • Providing General Anesthesia: Ketamine is used to induce general anesthesia alone or in combination with other general anesthetics, such as nitrous oxide. They utilize it in the emergency room to create short-term drowsiness for treating fractures and joint dislocations. Healing wounds in unwilling patients, such as children.

  • Pain Relief: To relieve severe pain caused by the following conditions, practitioners utilize minimal doses that do not cause dissociation:

  • Abdomen pain due to trauma fractures.

  • Arm or leg ache.

  • Low back ache.

A Cochrane review found 27 of 37 studies showed that using Ketamine significantly reduced pain after surgery. Most studies have shown that when Ketamine is used as an add-on anesthetic, the need for opioids drops in the first few days after surgery without a significant increase in bad outcomes. Ketamine is especially helpful for treating post-surgery pain in people who are on long-term opioid therapy.

How Does Aspirin and Ketamine Combination Work for Pain Management?

Abdominal pain is one of the common reasons people seek treatment at the emergency department (ED), accounting for more than 70 percent of all visits in which patients indicated pain as their primary complaint. Musculoskeletal pain (MSK) is experienced by one in every three persons and is the leading cause of serious long-term pain, physical impairment, and under-treatment in emergency departments. Due to the opioid epidemic, several classes of non-opioid analgesics, such as Acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs: Aspirin, Ibuprofen, and Diclofenac), local anesthetics, and Ketamine have gained a great deal of attention as viable alternatives to opioids for the management of acute muscle and joint pain in the emergency department.

Ketamine is a non-competitive N-methyl-d-aspartate (NMDA) receptor antagonist that is frequently used in the emergency department at sub-dissociative doses of 0.1 to 0.3 mg/lb when administered intravenously (IV) at 0.75 to 1 mg/lb when administered intranasally, and at 1 to 1.5 mg/lb when administered through inhalation.

Ketamine taken orally is metabolized extensively in the first pass, and as a result, its total bioavailability is only around 16 % of that of the intravenous route. Despite this, it was shown that injectable Ketamine at a dose of 0.25 to 0.5 mg/lb that was given orally was beneficial for changing burn wound dressings. The research that supports using oral Ketamine as an analgesic is restricted to case reports and case series. The results of these studies are discordant in terms of dose ranges and primary outcomes. In addition, the high rates of sedation and dissociation that prevent oral Ketamine from being used in outpatient settings have prompted the medical community to investigate further the roles that the intranasal and intravenous administration routes of Ketamine can play.

Aspirin is a non-selective and irreversible NSAID that inhibits the activity of both cyclooxygenase-1 and 2 and hinders the synthesis of prostaglandins and thromboxanes. It does all of these things by preventing the production of prostaglandins and thromboxanes. Whether taken on its own or combined with other medications, Aspirin is a standard over-the-counter pain treatment. Aspirin is used in the emergency department (ED) for the treatment of headaches in addition to its use as an antiplatelet or antithrombotic drug.

Even though Aspirin potentiates and increases the number of NMDA receptors, which reduces the analgesic efficacy of Ketamine, a combination of Ketamine and Aspirin could lead to more effective analgesia for MSK pain than either medication alone, according to a theory put forth by Vitalis Analgesics.

Because it possesses a rapidly dissolvable outer shell, the Aspirin formulation that Vitalis Analgesics has developed is a proprietary one. It can reduce pain more quickly and effectively than regular Aspirin does.

Conclusion

According to the studies, the analgesic efficacy of the combination of VTS-Aspirin and Ketamine in adult patients admitted to the emergency department (ED) with acute MSK pain demonstrated that this combination resulted in clinically significant (>1.3 points) pain relief in the 80 % of enrolled subjects with transient, non-serious adverse effects of weak intensity. This combination also had adverse effects that were mild in their intensity.

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Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)

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