Abstract
Objective
The aim of the study was to compare in emergency settings 2 analgesic regimens, morphine
with ketamine (K group) or morphine with placebo (P group), for severe acute pain
in trauma patients.
Methods
This was a prospective, multicenter, randomized, double-blind, clinical trial. Seventy-three
trauma patients with a severe acute pain defined as a visual analog scale (VAS) score of at least 60/100 were enrolled. Patients
in the K group received 0.2 mg · kg−1 of intravenous ketamine over 10 minutes, and patients in the P group received isotonic
sodium chloride solution. In both groups, patients were given an initial intravenous
morphine injection of 0.1 mg · kg−1, followed by 3 mg every 5 minutes. Efficient analgesia was defined as a VAS score not exceeding 30/100. The primary end points were morphine
consumption and VAS at 30 minutes (T30).
Results
At T30, morphine consumption was significantly lower in the K group vs the P group,
with 0.149 mg · kg−1 (0.132-0.165) and 0.202 mg · kg−1 (0.181-0.223), respectively (P < .001). The VAS score at T30 did not differ significantly between the 2 groups,
with 34.1 (25.6-42.6) in the K group and 39.5 (32.4-46.6) in the P group (P = not significant).
Conclusion
Ketamine was able to provide a morphine-sparing effect.
To read this article in full you will need to make a payment
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D; use, select 'Corporate R&D; Professionals'
Subscribe:
Subscribe to The American Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Délai d'obtention de l'analgésie en préhospitalier.Ann Fr Anesth Reanim. 2002; 21 ([abstract]): 324S
- Is morphine-induced sedation synonymous with analgesia during intravenous morphine titration?.Br J Anaesth. 2002; 89: 697-701
- The value of “multimodal” or “balanced analgesia” in postoperative pain treatment.Anesth-Analg. 1993; 77: 1048-1056
- Low doses ketamine: antihyperalgesic drug, non-analgesic.Ann Fr Anesth Reanim. 2005; 24: 11349-11359
- Nefopam and ketamine comparably enhance postoperative analgesia.Anesth Analg. 2005; 100: 169-174
- Small-dose ketamine enhances morphine-induced analgesia after outpatient surgery.Anesth Analg. 1999; 89: 98-103
- Synergistic antinociceptive effects of ketamine and morphine in the orofacial capsaicin test in the rat.Anesthesiology. 2003; 99: 969-975
- Interaction of a combination of morphine and ketamine on the nociceptive flexion reflex in human volunteers.Pain. 2002; 98: 47-57
- Analgesic and cognitive effects of intravenous ketamine-alfentanil combinations versus either drug alone after intradermal capsaicin in normal subjects.Anesth Analg. 1998; 86: 1250-1256
- The effect of ketamine on opioid-induced acute tolerance: can it explain reduction of opioid consumption with ketamine-opioid analgesic combinations?.Anesth Analg. 2000; 91: 1483-1488
- Short-term infusion of the μ-opioid agonist remifentanil in humans causes hyperalgesia during withdrawal.Pain. 2003; 106: 49-57
- A single small dose of postoperative ketamine provides rapid and sustained improvement in morphine analgesia in the presence of morphine-resistant pain.Anesth Analg. 2003; 96: 789-795
- Intravenous morphine at 0.1 mg/kg is not effective for controlling severe acute pain in the majority of patients.Ann Emerg Med. 2005; 46: 362-365
- Mechanisms of hyperalgesia and morphine tolerance: a current view of their possible interaction.Pain. 1995; 62: 259-274
- Survey of out-of-hospital emergency intubations in the French prehospital medical system: a multicenter study.Ann Emerg Med. 1998; 32: 454-460
- Controlled sedation with alphaxalone-alphadolone.Br J Med. 1974; 2: 256-259
- A quality control program for acute pain management in out-of-hospital critical care medicine.Ann Emerg Med. 1999; 34: 738-744
- Clinical significance of reported changes in pain severity.Ann Emerg Med. 1996; 27: 485-489
- An improved approximate formula for calculating sample sizes for comparing two binomial distributions.Biometrics. 1978; 34: 483-486
- Analgesia for acute musculoskeletal trauma: low-dose subcutaneous infusion of ketamine.Anaesth Intensive Care. 1996; 24: 32-36
- NMDA receptor antagonists: interactions with opioids.Acta Anaesthesiol Scand. 1997; 41: 112-115
- Combined opioid-NMDA antagonist therapies. What advantages do they offer the control of pain syndromes?.Drugs. 1998; 56: 1-5
- Pharmacology and mechanisms of opioid analgesic activity.Acta Anaesthesiol Scand. 1997; 41: 94-111
- The combination of NMDA antagonism and morphine produces profound antinociception in the rat dorsal horn.Brain Res. 1992; 573: 321-323
- Effects of ketamine on sensory perception: evidence for a role of N-methyl-d-aspartate receptors.J Pharmacol Exp Ther. 1992; 260: 1209-1213
- Subanesthetic effects of noncompetitive NMDA antagonist, ketamine, in humans: psychomimetic, perceptual, cognitive and neuroendocrine responses.Arch Gen Psychiatry. 1994; 14: 144-153
- Perioperative ketamine for acute post-operative pain: a quantitative and qualitative systematic review (Cochrane review).Acta Anaesthesiol Scand. 2005; 49: 1405-1428
- Cognitive impairment after small-dose ketamine isomer in comparison to equianalgesic racemic ketamine in human volunteers.Anesthesiology. 2002; 96: 357-366
Article Info
Publication History
Accepted:
November 2,
2006
Received in revised form:
November 1,
2006
Received:
July 1,
2006
Footnotes
Presented at the European Society of Anaesthesiology Congress in Madrid, Spain, June 3-6, 2006.
☆Support was provided solely by institutional and/or departmental sources.
Identification
Copyright
© 2007 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
