Management of severe acute pain in emergency settings: ketamine reduces morphine consumption.
OBJECTIVE
The aim of the study was to compare in emergency settings 2 analgesic regimens, morphine with ketamine (K group) or morphine with placebo (P group), for severe acute pain in trauma patients.


METHODS
This was a prospective, multicenter, randomized, double-blind, clinical trial. Seventy-three trauma patients with a severe acute pain defined as a visual analog scale (VAS) score of at least 60/100 were enrolled. Patients in the K group received 0.2 mg x kg(-1) of intravenous ketamine over 10 minutes, and patients in the P group received isotonic sodium chloride solution. In both groups, patients were given an initial intravenous morphine injection of 0.1 mg x kg(-1), followed by 3 mg every 5 minutes. Efficient analgesia was defined as a VAS score not exceeding 30/100. The primary end points were morphine consumption and VAS at 30 minutes (T30).


RESULTS
At T30, morphine consumption was significantly lower in the K group vs the P group, with 0.149 mg x kg(-1) (0.132-0.165) and 0.202 mg x kg(-1) (0.181-0.223), respectively (P < .001). The VAS score at T30 did not differ significantly between the 2 groups, with 34.1 (25.6-42.6) in the K group and 39.5 (32.4-46.6) in the P group (P = not significant).


CONCLUSIONS
Ketamine was able to provide a morphine-sparing effect.
Galinski
Michel
M
Samu 93-EA 3409 Avicenne Hospital, 93009 Bobigny Cedex, France. michel.galinski@avc.ap-hop-paris.fr
Dolveck
François
F
Combes
Xavier
X
Limoges
Véronique
V
Smaïl
Nadia
N
Pommier
Véronique
V
Templier
François
F
Catineau
Jean
J
Lapostolle
Frédéric
F
Adnet
Frédéric
F
D000208:Acute Disease; D000328:Adult; D000700:Analgesics / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004635:Emergency Medicine / Q000379:methods; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D007649:Ketamine / Q000008:administration & dosage*; D008297:Male; D009020:Morphine / Q000008:administration & dosage*; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D017060:Patient Satisfaction; D011229:Preanesthetic Medication; D011446:Prospective Studies; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications*
D000700:Analgesics; D007649:Ketamine; D009020:Morphine