A new prospective, randomized, double-blind trial compared subdissociative ketamine to morphine for acute pain in the ED.
What they did
45 patients received IV ketamine 0.3 mg/kg (mean baseline pain score 8.6)
45 patients received IV morphine 0.1 mg/kg (mean baseline pain score 8.5)
Source of pain was abdominal for ~70% in each group
Exclusion criteria was pretty standard
What they found
Pain score at 30 minutes: 4.1 for ketamine vs. 3.9 for morphine (p = 0.97)
No difference in the incidence of rescue fentanyl analgesia at 30 or 60 minutes
No serious adverse events occurred in either group
Patients in the ketamine group reported increased minor adverse effects at 15 minutes post-drug administration
Application to clinical practice
In an effort to reduce opioid use in the ED, low-dose ketamine may be a reasonable alternative to opioids for acute analgesia.
State nursing regulations govern who can administer IV ketamine in the ED.
What to prescribe on discharge? Lead author Dr. Motov recommends a "pain syndrome targeted" approach with "patient-specific opioid and non-opioid analgesics."
References
Motov S, et al. Intravenous subdissociative-dose ketamine versus morphine for analgesia in the emergency department: a randomized controlled trial. Ann Emerg Med 2015;66:222-9. [PMID 25817884]
