NEW YORK (Reuters Health) Jan 25 - Out in the field, giving ketamine after an initial dose of morphine is more effective than continuing morphine in adults with significant trauma injuries, according to Australian researchers.
"Furthermore, adverse events were uncommon in this nonphysician EMS setting," they reported online January 16 in Annals of Emergency Medicine.
Dr. Paul Andrew Jennings of Monash University in Melbourne, Victoria, and colleagues note that while morphine is commonly used for acute traumatic pain, it often causes respiratory depression and nausea.
Ketamine is appealing for use in the out-of-hospital setting, they explain, because of its analgesic and dissociative properties and its opioid-sparing effect. In addition, they write, "it is purported to allow patients to maintain their pharyngeal reflexes and maintain their own airway, even when fully dissociated."
To investigate further, the team conducted a randomized open-label trial involving 135 adults with significant out-of-hospital trauma pain and verbal pain scores greater than 5 after receiving 5 mg IV morphine. They were then assigned to receive a 10- or 20-mg bolus of ketamine followed by 10 mg every three minutes, or 5 mg of morphine every five minutes, until pain free.
Median baseline pain scores were 7.5 in the ketamine group and 7.0 in the morphine group. Scores were reduced by -5.6 and -3.2 points in the two groups, respectively, the authors report. The difference of 2.4 points in favor of the ketamine protocol exceeded the specified 1.3 points for a minimum clinically important effect.
Furthermore, the ketamine group had a faster reduction in pain than the morphine group, the report indicates.
Adverse effects were minor, although the rate was higher with ketamine (39%) than morphine-only (14%). No adverse event required withdrawal from the study, Dr. Jennings and colleagues note.
Summing up, they conclude, "Supplementing out-of-hospital opioids with low-dose ketamine is an effective strategy to mitigate trauma pain."
They add, "Given the success of intravenous ketamine in the reduction of refractory acute pain, future research should focus on the effectiveness of alternative routes of administration, including intramuscular, intranasal, and topical applications. Furthermore, the utility of various dosing regimens such as continuous or patient-controlled infusion needs to be explored with respect to effectiveness and ease of out-of-hospital maintenance and administration."
"Furthermore, adverse events were uncommon in this nonphysician EMS setting," they reported online January 16 in Annals of Emergency Medicine.
Dr. Paul Andrew Jennings of Monash University in Melbourne, Victoria, and colleagues note that while morphine is commonly used for acute traumatic pain, it often causes respiratory depression and nausea.
Ketamine is appealing for use in the out-of-hospital setting, they explain, because of its analgesic and dissociative properties and its opioid-sparing effect. In addition, they write, "it is purported to allow patients to maintain their pharyngeal reflexes and maintain their own airway, even when fully dissociated."
To investigate further, the team conducted a randomized open-label trial involving 135 adults with significant out-of-hospital trauma pain and verbal pain scores greater than 5 after receiving 5 mg IV morphine. They were then assigned to receive a 10- or 20-mg bolus of ketamine followed by 10 mg every three minutes, or 5 mg of morphine every five minutes, until pain free.
Median baseline pain scores were 7.5 in the ketamine group and 7.0 in the morphine group. Scores were reduced by -5.6 and -3.2 points in the two groups, respectively, the authors report. The difference of 2.4 points in favor of the ketamine protocol exceeded the specified 1.3 points for a minimum clinically important effect.
Furthermore, the ketamine group had a faster reduction in pain than the morphine group, the report indicates.
Adverse effects were minor, although the rate was higher with ketamine (39%) than morphine-only (14%). No adverse event required withdrawal from the study, Dr. Jennings and colleagues note.
Summing up, they conclude, "Supplementing out-of-hospital opioids with low-dose ketamine is an effective strategy to mitigate trauma pain."
They add, "Given the success of intravenous ketamine in the reduction of refractory acute pain, future research should focus on the effectiveness of alternative routes of administration, including intramuscular, intranasal, and topical applications. Furthermore, the utility of various dosing regimens such as continuous or patient-controlled infusion needs to be explored with respect to effectiveness and ease of out-of-hospital maintenance and administration."
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