title: Intravenous Subdissociative-Dose Ketamine Versus Morphine for Analgesia in the Emergency Department: A Randomized Controlled Trial.
abstract: OBJECTIVE
  We assess and compare the analgesic efficacy and safety of subdissociative intravenous-dose ketamine with morphine in emergency department (ED) patients.
  
  
  METHODS
  This was a prospective, randomized, double-blind trial evaluating ED patients aged 18 to 55 years and experiencing moderate to severe acute abdominal, flank, or musculoskeletal pain, defined as a numeric rating scale score greater than or equal to 5. Patients were randomized to receive ketamine at 0.3 mg/kg or morphine at 0.1 mg/kg by intravenous push during 3 to 5 minutes. Evaluations occurred at 15, 30, 60, 90, and 120 minutes. Primary outcome was reduction in pain at 30 minutes. Secondary outcome was the incidence of rescue analgesia at 30 and 60 minutes.
  
  
  RESULTS
  Forty-five patients per group were enrolled in the study. The primary change in mean pain scores was not significantly different in the ketamine and morphine groups: 8.6 versus 8.5 at baseline (mean difference 0.1; 95% confidence interval -0.46 to 0.77) and 4.1 versus 3.9 at 30 minutes (mean difference 0.2; 95% confidence interval -1.19 to 1.46; P=.97). There was no difference in the incidence of rescue fentanyl analgesia at 30 or 60 minutes. No statistically significant or clinically concerning changes in vital signs were observed. No serious adverse events occurred in either group. Patients in the ketamine group reported increased minor adverse effects at 15 minutes post-drug administration.
  
  
  CONCLUSIONS
  Subdissociative intravenous ketamine administered at 0.3 mg/kg provides analgesic effectiveness and apparent safety comparable to that of intravenous morphine for short-term treatment of acute pain in the ED.
authors.affiliation: Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY. Electronic address: smotov@maimonidesmed.org.
authors.forename: Sergey
authors.initials: S
authors.lastname: Motov
authors.affiliation: Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY.
authors.forename: Bradley
authors.initials: B
authors.lastname: Rockoff
authors.affiliation: Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY; Long Island University School of Pharmacy, Brooklyn, NY.
authors.forename: Victor
authors.initials: V
authors.lastname: Cohen
authors.affiliation: Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY.
authors.forename: Illya
authors.initials: I
authors.lastname: Pushkar
authors.affiliation: Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY.
authors.forename: Antonios
authors.initials: A
authors.lastname: Likourezos
authors.affiliation: Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY.
authors.forename: Courtney
authors.initials: C
authors.lastname: McKay
authors.affiliation: Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY.
authors.forename: Emil
authors.initials: E
authors.lastname: Soleyman-Zomalan
authors.affiliation: Office of Research Administration, Maimonides Medical Center, Brooklyn, NY; Department of Medicine, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Peter
authors.initials: P
authors.lastname: Homel
authors.affiliation: Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY.
authors.forename: Victoria
authors.initials: V
authors.lastname: Terentiev
authors.affiliation: Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY.
authors.forename: Christian
authors.initials: C
authors.lastname: Fromm
mesh_terms: D059787:Acute Pain; D000328:Adult; D000698:Analgesia / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000778:Anesthetics, Dissociative / Q000008:administration & dosage; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007649:Ketamine / Q000008:administration & dosage; D008297:Male; D009020:Morphine / Q000008:administration & dosage; D010147:Pain Measurement / Q000379:methods*; D013995:Time
chemical_list: D000701:Analgesics, Opioid; D000778:Anesthetics, Dissociative; D007649:Ketamine; D009020:Morphine