Management of severe acute pain in emergency settings: ketamine reduces morphine consumption

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 center dot kg(-1) (0.132-0.165) and 0.202 mg center dot kg(-1) (0.181-0.223), respectively (P <.00 1). 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. (C) 2007 Elsevier Inc. All rights reserved.