title: Comparing low-dose intravenous ketamine-midazolam with intravenous morphine with respect to pain control in patients with closed limb fracture.
abstract: BACKGROUND
  We assessed the effects of low-dose IV ketamine-midazolam versus morphine on pain control in patients with closed limb fracture(s); and also compared the incidence of adverse events (cardio-pulmonary) between two groups.
  
  
  METHODS
  This prospective, single-blind, non-inferiority trial randomized consecutive emergency department (ED) patients aged 18-60 years to two groups: Receiving 300-500 mcg/kg ketamine plus 0.03 mg/kg midazolam, or 0.05-0.1 mg/kg morphine. Visual analogue score (VAS) and adverse events were verified during an interval of 30 minutes.
  
  
  RESULTS
  Two hundred and thirty - six patients were selected, among whom 207 were males (87.3%). The average age was 29 ± 2, (range, 18-60 years). The VAS score at T30 (i.e., 30 minutes after initial analgesic dose) was significantly decreased compared with VAS score at T0, in both groups. No statistically significant difference, however, was observed between the two groups (-6.1 ± 1.1 versus -6.2 ± 1.0; P = 0.16). With regard to systolic blood pressure and respiratory rate, however, a meaningful difference was noted between the two groups (1.5 ± 6.4 versus -2.1 ± 6.6; P = 0.000 for SBP, and -0.2 ± 1.1 versus -1.1 ± 6.1; P = 0.048 for RR).
  
  
  CONCLUSIONS
  Low-dose intravenous ketamine plus midazolam has the same analgesic effects as morphine on pain control in trauma patients with closed limb fracture(s), in addition to less respiratory adverse events.
authors.affiliation: Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Omid
authors.initials: O
authors.lastname: Ahmadi
authors.affiliation: Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mehdi Nasr
authors.initials: MN
authors.lastname: Isfahani
authors.affiliation: Department of Biostatistics and Epidemiology School of Health, Isfahan University Medical Sciences, Isfahan, Iran.
authors.forename: Awat
authors.initials: A
authors.lastname: Feizi
keywords: Closed limb fracture; ketamine; midazolam; morphine