Abstract
Objectives
To compare the maximum change in numeric rating scale (NRS) pain scores, in patients
receiving low-dose ketamine (LDK) or morphine (MOR) for acute pain in the emergency
department.
Methods
We performed an institutional review board–approved, randomized, prospective, double-blinded
trial at a tertiary, level 1 trauma center. A convenience sample of patients aged
18 to 59 years with acute abdominal, flank, low back, or extremity pain were enrolled.
Subjects were consented and randomized to intravenous LDK (0.3 mg/kg) or intravenous MOR (0.1 mg/kg). Our primary outcome was the maximum change in NRS scores. A sample size of
20 subjects per group was calculated based on an 80% power to detect a 2-point change
in NRS scores between treatment groups with estimated SDs of 2 and an α of .05, using a repeated-measures linear model.
Results
Forty-five subjects were enrolled (MOR 21, LDK 24). Demographic variables and baseline
NRS scores (7.1 vs 7.1) were similar. Ketamine was not superior to MOR in the maximum
change of NRS pain scores, MOR = 5 (confidence interval, 6.6-3.5) and LDK = 4.9 (confidence interval, 5.8-4). The time to achieve maximum reduction in NRS pain
scores was at 5 minutes for LDK and 100 minutes for MOR. Vital signs, adverse events, provider, and nurse satisfaction scores
were similar between groups.
Conclusion
Low-dose ketamine did not produce a greater reduction in NRS pain scores compared
with MOR for acute pain in the emergency department. However, LDK induced a significant
analgesic effect within 5 minutes and provided a moderate reduction in pain for 2
hours.
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Article Info
Publication History
Published online: January 06, 2015
Accepted:
December 24,
2014
Received in revised form:
December 24,
2014
Received:
May 29,
2014
Footnotes
☆Grant: We received a research grant from the Office of the Air Force Surgeon General to support this study (Award No. C.2011.173 ).
☆☆Meetings: Society for Academic Emergency Medicine Annual Meeting; Atlanta, GA; May 2013; oral presentation.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
