Authors: Stine Fjendbo Galili, Bodil Hammer Bech, Hans Kirkegaard, Jette Ahrensberg, Lone Nikolajsen
Published in: Academic Emergency Medicine, July 17, 2024
Conclusions: Low-dose ketamine, when used as an adjunct to morphine, effectively enhances short-term pain relief in ED patients, regardless of their opioid use history. While promising, this approach may increase the risk of certain side effects, which necessitates careful consideration in clinical practice.
Methods: This study involved adult patients presenting to the ED with acute pain rated ≥5 on a numeric rating scale (0-10). Participants were randomized to receive either 0.1 mg/kg ketamine or isotonic saline as an adjunct to morphine. The study included separate randomizations for patients with and without current opioid use. Pain was assessed at multiple intervals: baseline (T0), and at 10, 20, 30, 45, 60, and 120 minutes post-administration. The primary outcome was pain reduction from T0 to T10. Secondary outcomes included ongoing pain intensity, the need for rescue opioids, side effects, and patient and provider satisfaction.
Results: The study enrolled 116 patients from May 2022 to August 2023. The median age was 51 years, with 58% male and 36% reporting current opioid use. The ketamine group experienced significantly greater pain reduction at T10 compared to the placebo group (median pain reduction: 4 vs. 1, p = 0.001). This effect persisted through T30. Patients in the ketamine group were more likely to experience nausea, vomiting, and dissociation in the initial 10 minutes post-administration.
Galili, S.F., Bech, B.H., Kirkegaard, H., Ahrensberg, J. and Nikolajsen, L., 2024. Low‐dose ketamine as an adjunct to morphine: A randomized controlled trial among patients with and without current opioid use. Academic Emergency Medicine.