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Original research
Ketamine decreased opiate use in US military combat operations from 2010 to 2019
  1. Sally L Westcott1,2,
  2. A Wojahn1,3,
  3. T C Morrison1 and
  4. E Leslie1,4
  1. 1Emergency Department, Combat Trauma Research Group, NMCSD, San Diego, California, USA
  2. 2Emergency Department, Naval Hospital Guam, Agana Heights, Guam
  3. 3Shock Trauma Platoon, Combat Logistics Battalion 13, 13th Marine Expeditionary Unit, Marine Corps Base Camp Pendleton, Camp Pendleton, California, USA
  4. 41st Medical Battalion, 1st Marine Logistics Group, 1st Marine Expeditionary Unit, Marine Corps Base Camp Pendleton, Camp Pendleton, California, USA
  1. Correspondence to Dr Sally L Westcott, Combat Trauma Research Group, NMCSD, San Diego, CA 92134, USA; slmwestcott{at}gmail.com

Abstract

Background Ketamine is a dissociative anaesthetic currently used in a variety of healthcare applications. Effects are dose dependent and cause escalating levels of euphoria, analgesia, dissociation and amnesia. Ketamine can be given via intravenous, intramuscular, nasal, oral and aerosolised routes. A 2012 memorandum and the 2014 Tactical Combat Casualty Care (TCCC) guidelines included ketamine as part of the ‘Triple Option’ for analgesia. This study investigated the effect of ketamine adoption by the US military TCCC guidelines on opioid use between 2010 and 2019.

Methods This was a retrospective review of deidentified Department of Defense Trauma Registry data. The study was approved by the Institutional Review Board of Naval Medical Center San Diego (NMCSD) and facilitated by a data sharing agreement between NMCSD and the Defense Health Agency. Patient encounters from all US military operations from January 2010 to December 2019 were queried. All administrations of any pain medications via any route were included.

Results 5965 patients with a total of 8607 pain medication administrations were included. Between 2010 and 2019, the yearly percentage of ketamine administrations rose from 14.2% to 52.6% (p<0.001). The percentage of opioid administrations decreased from 85.8% to 47.4% (p<0.001). Among the 4104 patients who received a single dose of pain medication, the mean Injury Severity Score for those who received ketamine was higher than for those who received an opioid (mean=13.1 vs 9.8, p<0.001).

Conclusion Military opioid use declined as ketamine use increased over 10 years of combat. Ketamine is generally used first for more severely injured patients and has increasingly been employed by the US military as the primary analgesic for combat casualties.

  • pain management
  • trauma management
  • accident & emergency medicine

Data availability statement

Data may be obtained from a third party and are not publicly available. Data were obtained through a data sharing agreement (DSA) with the Joint Trauma System (JTS) through the Defense Health Agency and are only available to those listed on the DSA.

https://doi.org/10.1136/military-2022-002291

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. Data were obtained through a data sharing agreement (DSA) with the Joint Trauma System (JTS) through the Defense Health Agency and are only available to those listed on the DSA.

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    Footnotes

    • Contributors SLW, AW and EL developed the hypothesis and research topic. SLW and AW obtained the data and crafted the data sharing agreement with the Defense Health Agency (DHA). SLW, AW and TCM developed the analysis questions. TCM analysed the data. All authors contributed to the creation of the manuscript. SLW is responsible for the overall work as the guarantor. SLW accepts full responsibility for the finished work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.