Efficacy of Small Doses of Ketamine With Morphine to Decrease Procedural Pain Responses During Open Wound Care

Arroyo-Novoa, Carmen Mabel; Figueroa-Ramos, Milagros I.; Miaskowski, Christine; Padilla, Geraldine; Paul, Steven M.; Rodríguez-Ortiz, Pablo; Stotts, Nancy A.; Puntillo, Kathleen

doi:10.1097/ajp.0b013e318211936a

Cited by 25 publications

(9 citation statements)

References 25 publications

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“…In several studies, the use of low doses of ketamine plus morphine to control postoperative pain has resulted into reduction of the morphine dosage and the more effective pain control (14,15). These results were in agreement with other studies of acute non-surgical pain (16)(17)(18)(19). The purpose of the present study was to compare the effect of morphine and the addition of ketamine in two different doses to morphine to control acute pain caused by limb trauma.…”

Section: Introductionsupporting

confidence: 88%

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

2020

jcr

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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.

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Section: Introductionsupporting

confidence: 88%

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

2020

jcr

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“…There is some evidence that ketamine coadministered with morphine can significantly increase the efficacy of morphine in cancer pain management . The majority of preclinical (Trujillo and Akil, 1994;Shimoyama et al, 1996;González et al, 1997;Miyamoto et al, 2000) and human (Bell, 1999;Nesher et al, 2009;Arroyo-Novoa et al, 2011;Hardy et al, 2012;Honarmand et al, 2012;Mathews et al, 2012;Salas et al, 2012;Suppa et al, 2012) studies have focused on the pharmacodynamic properties of ketamine as an antagonist of the NMDA receptor leading to decreased opioid tolerance and hyperalgesia. However, very little information is available of any possible pharmacokinetic interactions between opioids and ketamine.…”

Section: Introductionmentioning

confidence: 99%

Ketamine coadministration attenuates morphine tolerance and leads to increased brain concentrations of both drugs in the rat

Lilius

Jokinen

Neuvonen

et al. 2015

British J Pharmacology

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Background and PurposeThe effects of ketamine in attenuating morphine tolerance have been suggested to result from a pharmacodynamic interaction. We studied whether ketamine might increase brain morphine concentrations in acute coadministration, in morphine tolerance and morphine withdrawal.Experimental ApproachMorphine minipumps (6 mg·day–1) induced tolerance during 5 days in Sprague–Dawley rats, after which s.c. ketamine (10 mg·kg–1) was administered. Tail flick, hot plate and rotarod tests were used for behavioural testing. Serum levels and whole tissue brain and liver concentrations of morphine, morphine-3-glucuronide, ketamine and norketamine were measured using HPLC-tandem mass spectrometry.Key ResultsIn morphine-naïve rats, ketamine caused no antinociception whereas in morphine-tolerant rats there was significant antinociception (57% maximum possible effect in the tail flick test 90 min after administration) lasting up to 150 min. In the brain of morphine-tolerant ketamine-treated rats, the morphine, ketamine and norketamine concentrations were 2.1-, 1.4- and 3.4-fold, respectively, compared with the rats treated with morphine or ketamine only. In the liver of morphine-tolerant ketamine-treated rats, ketamine concentration was sixfold compared with morphine-naïve rats. After a 2 day morphine withdrawal period, smaller but parallel concentration changes were observed. In acute coadministration, ketamine increased the brain morphine concentration by 20%, but no increase in ketamine concentrations or increased antinociception was observed.Conclusions and ImplicationsThe ability of ketamine to induce antinociception in rats made tolerant to morphine may also be due to increased brain concentrations of morphine, ketamine and norketamine. The relevance of these findings needs to be assessed in humans.

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“…Although, analgesic consumption after surgery can reduce postoperative side effects, but, pain is not controlled completely in most cases (2, 3). Laparoscopic cholecystectomy is a standard treatment for cholelithiasis, due to decreased postoperative trauma and its side effects.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Single-Dose Administration of Dexamethasone on Postoperative Pain in Patients Undergoing Laparoscopic Cholecystectomy

et al. 2014

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Background:Postoperative pain is considered as a reason of patient’s delay in discharge and disability aggravation. Therefore, multimodal approaches have been suggested in order to mitigate pain and decrease postoperative side effects.Objectives:The aim of this study was to evaluate analgesic effect of a single dose injection of dexamethasone on reducing postoperative pain in laparoscopic cholecystectomy.Patients and Methods:In this double-blind, prospective study, 122 patients aged 18-60 years old, whom were selected for laparoscopic cholecystectomy, were classified into two case and control groups, and 61 patients were included in each group. The case (D) group underwent general anesthesia and a single- dose intravenous injection of dexamethasone. The Control (C) group received general anesthesia and intravenous injection of normal saline. Total dose of consumed meperidine and pain intensity during first 24 hours were evaluated in both groups.Results:No significant difference existed between two groups regarding age, sex, weight and operation time. Pain intensity in group D was significantly less than group C (P < 0.01) after two, six and 12 hoursof surgery. No significant difference existed in pain intensity between two groups at the beginning of and 24 hours after the surgery (P > 0.05). Meperidine consumption in group D was significantly less than group C (P < 0.05).Conclusions:Findings of present study showed that single dose of intravenous dexamethasone, led to less pain intensity and amounts of meperidine consumption, in comparison with placebo.

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Efficacy of Small Doses of Ketamine With Morphine to Decrease Procedural Pain Responses During Open Wound Care

Cited by 25 publications

References 25 publications

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

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

Ketamine coadministration attenuates morphine tolerance and leads to increased brain concentrations of both drugs in the rat

The Effect of Single-Dose Administration of Dexamethasone on Postoperative Pain in Patients Undergoing Laparoscopic Cholecystectomy

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