Clinical Trial Comparison of Analgesic Effect of Morphine Along With Different Doses of Ketamine and Prescription of Morphine Alone for Controlling Pain in Trauma Patients

Abstract

Introduction: Effective pain control with minimal side effects is one of the most important tasks of emergency physicians in trauma patients. In this randomized clinical trial, the effect of low doses of ketamine in trauma patients with moderate to severe pain were compared with morphine sulfate. Materials and Methods: This double-blind clinical trial study was conducted in three academic hospitals. Trauma patients (acute limb trauma) over 18 years old with moderate to severe pain (VAS≥5) were assigned into three groups: group A received 0.1 mg/kg morphine plus 2 cc normal saline as a placebo. Group B received the same dose Morphine sulfate in addition to Ketamine 0.15mg/kg and group C received morphine plus Ketamine 0.3 mg/kg. Patient's pain was recorded based on VAS system at pre-injection and 15, 30, 60, 120, 90, 150 and 180 times after injection. Results: A total of 187 people participated in the study. Pain score was decreased more rapidly and effectively in group C compared to A and B (P<0.001). Need for repeated morphine doses for pain control was higher in group A at 15 and 30 min after injection of first dose (p<0.001). Dysphoria was higher in group C (p<0.001) and nausea occurred significantly more frequent in group A (p=0.004). Conclusion: Results of the present study are similar to other studies in this field and we can conclude that adding of ketamine to morphine decreases pain more effectively and rapidly and also decreases the need for repeated morphine injection. It is hoped that in the near future this drug can be used as one of the usual treatments for moderate to severe pains in the presence of opiate or even alone in the emergency room.

Subanaesthetic single-dose ketamine as an adjunct to opioid analgesics for acute pain management in the emergency department: a systematic review and meta-analysis

“…Two studies reported patient satisfaction on a 5-point Likert Scale rated as very low, low, fair, good or excellent. 40 41 The pooled estimate suggested a significant difference in mean patient satisfaction with pain control favouring adjuvant SDK (MD 0.56; 95% CI 0.35 to 0.76) (see online supplemental figure 3 ).…”

“…Five studies reported the mean age of patients ranging from 31.6 years 43 to 42.5 17 years. Three studies examined patients with an acute pain score ≥3, 45 ≥5 44 or ≥6 17 out of 10 on an 11-point Numerical Rating Scale (NRS), two studies examined patients with limb trauma, 40 43 two studies examined patients with renal colic and NRS ≥6 39 42 and one study examined patients with long bone fractures and NRS ≥7. 41 …”

“… 41 Adjuvant SDK doses administered intravenously varied between 0.1 mg/kg 17 and 0.3 mg/kg. 40 44 45 Adjuvant SDK doses administered by intranasal (IN) and inhalation routes were 1.0 mg/kg 43 and 1.5 mg/kg, respectively. 41 Based on bioavailability of IN (25%–50%) 46 and nebulised (inhaled) (20%–40%) 47 48 ketamine, the systemic absorption for 1.0 mg/kg IN and 1.5 mg/kg nebulised ketamine would approximate 0.25–0.5 mg/kg and 0.3–0.6 mg/kg intravenous (IV) ketamine, respectively.…”

“…All included studies were published between 2014 and 2020 (table 1). Five studies were conducted in Iran [39][40][41][42][43] and three were from the USA. 17 44 45 A total of 903 patients were randomised to treatment arms; of which 897 patients were included in formal analyses (69.1% were male; 485 were assigned to intervention and 412 to control).…”