Acute Pain Management in Emergency Department, Low Dose Ketamine Versus Morphine, A Randomized Clinical Trial

Abstract

BackgroundKetamine, as an opium alternative, has been proposed for pain relief in the emergency department (ED).ObjectivesThis study was carried out to compare low dose ketamine (LDK) with morphine for pain relief in trauma patients.MethodsIn this randomized double-blinded clinical trial, 300 trauma patients from the ED of 2 teaching hospitals in Tehran, Iran were enrolled and randomly divided into 2 equal groups. The 1st group received 0.2 mg/kg of ketamine while the 2nd group received 0.1 mg/kg of intravenous morphine. The pain intensity and complications were measured and compared every 15 minutes to 1 hour.ResultsFifteen minutes after drug injection in both groups, a significant reduction was found in average pain intensity compared to the initial pain (P = 0.01). At 15 minutes, no significant difference was found in both groups in regards to average pain intensity (P = 0.23). The average pain intensity at 30, 45, and 60 minutes in the group receiving morphine was lower than the ketamine group (P = 0.01, P < 0.001, P < 0.001 respectively). Two complications (drop in O2 saturation below 90% and flushing) were significantly greater in the morphine group.ConclusionsThe results of this study suggest that LDK, at a dose of 0.2 mg/kg, in the earlier minutes leads to significant reduction of pain when compared to that of intravenous morphine. It also created fewer complications than morphine.

Comparative safety and efficacy of low dose ketamine and opioids for acute pain management at the emergency department

“…Among minor AE's observed were reduced respiratory rate (16.1% vs 12.5%), pruritis (5% vs 7.5%), decreased O2 saturation (3.3% vs 9.3%) and urinary distention (0.4% vs 1.1%). These incidences were high in morphine group but were temporary and no additional pharmacological interventions were applied ( flushing, dizziness, mood changes, hypotension and O2 saturation as the common AE's associated with both drugs 19 . 16% patients receiving LDK were observed with nausea vs 17% in opium group, no flushing incidences were seen among LDK patients while 36% patients receiving morphine reported flushing incidences, high cases of O2 saturation < 90% were observed in morphine group as compared to LDK group 19 .…”

Low Dose Ketamine Used for Acute Pain Management in the Emergency Department

“…Sub-dissociative dose of ketamine (SDK) also known as low dose ketamine has been shown to have successful pain control in chronic non-traumatic chest pain, musculoskeletal pain, vaso-occlusive pain and renal colic pain in the emergency department [18]. [19]. Morphine has been shown to have adverse side effects such as respiratory depression and over-sedation [19].…”

“…[19]. Morphine has been shown to have adverse side effects such as respiratory depression and over-sedation [19].…”

“…If low dose ketamine is used in the emergency department as a pharmacological treatment for pain, it is important to take into consideration the risks and benefits, least effective and most effective uses. Low dose ketamine is an effective pharmacological treatment of pain by itself and as an adjunct to opioids [7] [30] because it is a non-competitive NMDA antagonist and it does not interfere with receptors used by opioids [7] [19] [30]. As an adjunct therapy, it is especially important to consider the dosing of opioids in order to prevent opioid-ketamine adverse reactions.…”

Ketamine as Adjuvant for Acute Pain Management

“…Ketamine is a suitable analgesic for use outside the operating room, especially in emergency conditions, as it maintains cardiovascular and respiratory stability in patients, while causing potent analgesia similar to opioids, but lacking a risk of respiratory depression (19). Nowadays, concomitant administration of ketamine with propofol or in a mixture called "Ketofol" is performed in some medical centers, used to induce analgesia and sedation in some procedures (procedural sedation).…”