Abstract
Study objective
We compare the analgesic efficacy and safety of subdissociative intravenous-dose ketamine
(SDK) versus morphine in geriatric Emergency Department (ED) patients.
Methods
This was a prospective, randomized, double-blind trial evaluating ED patients aged
65 and older experiencing moderate to severe acute abdominal, flank, musculoskeletal,
or malignant pain. Patients were randomized to receive SDK at 0.3 mg/kg or morphine
at 0.1 mg/kg by short intravenous infusion over 15 min. Evaluations occurred at 15,
30, 60, 90, and 120 min. Primary outcome was reduction in pain at 30 min. Secondary
outcomes included overall rates of adverse effects and incidence of rescue analgesia.
Results
Thirty 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: 9.0 versus
8.4 at baseline (mean difference 0.6; 95% CI −0.30 to 1.43) and 4.2 versus 4.4 at
30 min (mean difference −0.2; 95% CI −1.93 to1.46). Patients in the SDK group reported
higher rates of psychoperceptual adverse effects at 15, 30, and 60 min post drug administration.
Two patients in the ketamine group and one in the morphine group experienced brief
desaturation episodes. There were no statistically significant differences with respect
to changes in vital signs and need for rescue medication.
Conclusion
SDK administered at 0.3 mg/kg over 15 min provides analgesic efficacy comparable to
morphine for short-term treatment of acute pain in the geriatric ED patients but results
in higher rates of psychoperceptual adverse effects.
ClinicalTrials.gov Registration #: NCT02673372.
Keywords
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Article Info
Publication History
Published online: May 17, 2018
Accepted:
May 13,
2018
Received:
April 4,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
