Diario de Manejo del Dolor y Medicina

Abstracto

Efficacy of Low Dose Intravenous Ketamine in Addition to Morphine for Immediate Pain Management of Opioid Abusers Presenting with Acute Osseous Fracture of Extremities

Hassan Amiri, Mohammad Javad Zarei, Niloofar Ghodrati, Samad Shams Vahdati, Zohre Bagheri Moayed

Background: Immediate pain management in patients presenting to the emergency department with acute fractures is obviously of utmost importance. However, this can be extremely challenging in situations like prior history of opioid abuse.

Methods: 128 patients with history of opioid abuse presenting to the emergency department with acute single fracture of long bones in either upper or lower extremities were included, randomized and received morphine (50 μg/kg) or morphine plus Ketamine (50 μg/kg morphine/100 μg/kg Ketamine) intravenously after obtaining informed consent. Pain severity was assessed using visual analogue pain scale before and after receiving the pain medication at 15, 30, 60 and 90 minutes.

Results: Severity of pain in treatment groups was not significantly different before treatment (7.48 ± 1.6 vs. 8.07 ± 1.5 for morphine and morphine/Ketamine groups, respectively, p value >0.05). The severity of pain in both groups significantly decreased following medicating but statistical analysis between 2 groups did not show any significant difference between study groups at any time point (p value >0.05). However, side effects significantly higher in the morphine/Ketamine group (82.6% vs. 46.2%, p value<0.001).

Conclusion: Ketamine in addition to morphine does not improve pain control in patients with acute osseous fracture of extremities and history of opioid abuse; it also results in more side effects compared to using morphine alone. Based on these findings, we recommend against cocktailing intravenous morphine with Ketamine for immediate pain relief in this patient population.