title: Morphine and ketamine is superior to morphine alone for out-of-hospital trauma analgesia: a randomized controlled trial.
abstract: OBJECTIVE
  We assess the efficacy of intravenous ketamine compared with intravenous morphine in reducing pain in adults with significant out-of-hospital traumatic pain.
  
  
  METHODS
  This study was an out-of-hospital, prospective, randomized, controlled, open-label study. Patients with trauma and a verbal pain score of greater than 5 after 5 mg intravenous morphine were eligible for enrollment. Patients allocated to the ketamine group received a bolus of 10 or 20 mg, followed by 10 mg every 3 minutes thereafter. Patients allocated to the morphine alone group received 5 mg intravenously every 5 minutes until pain free. Pain scores were measured at baseline and at hospital arrival.
  
  
  RESULTS
  A total of 135 patients were enrolled between December 2007 and July 2010. There were no differences between the groups at baseline. After the initial 5-mg dose of intravenous morphine, patients allocated to ketamine received a mean of 40.6 mg (SD 25 mg) of ketamine. Patients allocated to morphine alone received a mean of 14.4 mg (SD 9.4 mg) of morphine. The mean pain score change was -5.6 (95% confidence interval [CI] -6.2 to -5.0) in the ketamine group compared with -3.2 (95% CI -3.7 to -2.7) in the morphine group. The difference in mean pain score change was -2.4 (95% CI -3.2 to -1.6) points. The intravenous morphine group had 9 of 65 (14%; 95% CI 6% to 25%) adverse effects reported (most commonly nausea [6/65; 9%]) compared with 27 of 70 (39%; 95% CI 27% to 51%) in the ketamine group (most commonly disorientation [8/70; 11%]).
  
  
  CONCLUSIONS
  Intravenous morphine plus ketamine for out-of-hospital adult trauma patients provides analgesia superior to that of intravenous morphine alone but was associated with an increase in the rate of minor adverse effects.
authors.affiliation: Ambulance Victoria, Melbourne, Victoria, Australia. paul.jennings@monash.edu
authors.forename: Paul A
authors.initials: PA
authors.lastname: Jennings
authors.forename: Peter
authors.initials: P
authors.lastname: Cameron
authors.forename: Stephen
authors.initials: S
authors.lastname: Bernard
authors.forename: Tony
authors.initials: T
authors.lastname: Walker
authors.forename: Damien
authors.initials: D
authors.lastname: Jolley
authors.forename: Mark
authors.initials: M
authors.lastname: Fitzgerald
authors.forename: Kevin
authors.initials: K
authors.lastname: Masci
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D015601:Injury Severity Score; D007649:Ketamine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D007649:Ketamine; D009020:Morphine