[Not Available].

In a randomized open study of 120 adults with severe pain (numeric rating scale ≥6) in the emergency department, low-dose ketamine (30 mg bolus) was non-inferior to morphine (10 mg titration) for achieving a pain score below 4 within 10 minutes; the same number of patients in both groups reached that target. However, the average pain score was lower with ketamine, and adverse effects were more frequent in the ketamine group.

Study at a glance

Abstract

Severe pain is a therapeutic emergency that can be life-threatening by its location, its repercussions or the misdiagnosis it can cause. To investigate the efficacy of analgesia by morphine versus that by low-dose ketamine in severe pain in emergency department. We conducted a randomized open study. We included patients over 18 years-old who consulted for severe pain defined by numeric rating scale (NRS) ≥6. Patients of M group received a titration of 10 mg morphine while those of LDK group, received a bolus of 30 mg of ketamine. The primary endpoint was obtaining a NRS of less than 4 within 10 minutes. We included 120 patients, 66 in the M group and 54 in the LDK group. The mean baseline NRS was 8.8 ± 1.3 in the M group and 8.6 ± 1.4 in the LDK group (p₌ 0.7). At 10 minutes, the same number of patients in both groups achieved a NRS less than 4 (p = 0.09). However, the mean NRS was significantly lower in the LDK group (p = 0.008). More adverse effects were noted in the LDK group (p <10-3). Low-dose ketamine appears to be non-inferior to morphine in achieving effective analgesia for severe pain in the emergency department.