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A new prospective, randomized, double-blind trial compared subdissociative ketamine to morphine for acute pain in the ED.
What they did
- 45 patients received IV ketamine 0.3 mg/kg (mean baseline pain score 8.6)
- 45 patients received IV morphine 0.1 mg/kg (mean baseline pain score 8.5)
- Source of pain was abdominal for ~70% in each group
- Exclusion criteria was pretty standard
What they found
- Pain score at 30 minutes: 4.1 for ketamine vs. 3.9 for morphine (p = 0.97)
- No difference in the incidence of rescue fentanyl analgesia at 30 or 60 minutes
- No serious adverse events occurred in either group
- Patients in the ketamine group reported increased minor adverse effects at 15 minutes post-drug administration
Application to clinical practice
- In an effort to reduce opioid use in the ED, low-dose ketamine may be a reasonable alternative to opioids for acute analgesia.
- State nursing regulations govern who can administer IV ketamine in the ED.
- What to prescribe on discharge? Lead author Dr. Motov recommends a "pain syndrome targeted" approach with "patient-specific opioid and non-opioid analgesics."
References
Motov S, et al. Intravenous subdissociative-dose ketamine versus morphine for analgesia in the emergency department: a randomized controlled trial. Ann Emerg Med 2015;66:222-9. [PMID 25817884]
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