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The following is a summary of “Fentanyl versus nebulized ketamine for prehospital analgesia: A retrospective data review,” published in the March 2025 issue of American Journal of Emergency Medicine by McArthur et al. 

Researchers conducted a retrospective study to compare the effectiveness of fentanyl and ketamine administered via Breath Actuated Nebulizer (BAN) for analgesia in the prehospital setting.  

They assessed individuals who received fentanyl or ketamine via BAN for pain management in a large suburban EMS system between 03/01/2022 and 06/01/2023. The primary outcome was the change from the first to the last recorded pain score. A subgroup analysis focused on individuals with traumatic pain. Inverse Probability of Treatment Weighting (IPTW) and Propensity Score Matching (PSM) were applied to compare the treatment effects of fentanyl and ketamine via BAN among all individuals and those in the traumatic pain subgroup.  

The results showed that among 1,480 individuals, 1,317 (89.0%) received fentanyl, and 163 (11.0%) received ketamine via BAN. The unadjusted mean pain score change was −2.9 (SD 3.0) for fentanyl and −3.5 (SD 3.4) for ketamine. Propensity score analyses discovered no significant difference in pain score change between fentanyl and ketamine for all individuals (mean difference, IPTW: -0.45, 95% CI -1.18 to 0.28; PSM: -0.36, 95% CI -0.93 to 0.21). However, subgroup analysis of individuals with traumatic pain showed significantly greater pain reduction with ketamine compared to fentanyl (unadjusted: -1.37, 95% CI -2.20 to -0.54; IPTW: -1.10, 95% CI -1.96 to -0.23; PSM: -0.92, 95% CI -1.17 to -0.12).  

Investigators concluded that there was no difference in analgesic effectiveness between fentanyl and ketamine, but ketamine via BAN provided greater pain relief for traumatic pain, making it a viable option for prehospital pain management. 

Source: sciencedirect.com/science/article/abs/pii/S0735675724007162