Intranasal ketamine for acute traumatic pain

• 出 处: 中华物理医学与康复杂志
• 发表日期: 2017年39期

BACKGROUND AND OBJECTIVE

Opiates are the current mainstay of severe pain relief. Ketamine, an NMDA-antagonist, has been studied for its efficacy in analgesia and anesthesia. This study was designed to better understand the efficacy and safety of intranasal (IN) ketamine for use in the emergency department.

METHODS

This single center, randomized, prospective, clinical trial recruited patients ages 18 to 70 years presenting to the ER with orthopaedic pain rated as >80/100 on a visual analogue scale (VAS). Eligible subjects were randomized to receive IN ketamine (1 mg/kg), IM morphine (0.15 mg/kg IM) or IV morphine (0.1 mg/kg) in a 1：1：1 ratio. Vital signs and VAS measurements were recorded at five minute intervals. The primary outcome measure was the effectiveness of the drug in reducing pain intensity. The "time to onset" (TTO) was defined as the time until the patient reached a 15 mm VAS pain score reduction.

RESULTS

In the 90 patients recruited, the TTO for IN ketamine was 14.3 minutes, for IV morphine was 8.9 minutes (P＝0.30) and for IM morphine was 26 minutes (P＝0.003). The maximal VAS pain score reduction was 56 mm, 59 mm and 48 mm pain for the IN ketamine, IV morphine and IM morphine groups, respectively (P＝0.3). The time to maximum pain reduction was 40.4 minutes for IN ketamine, 33.4 minutes for IV morphine, and 46.7 minutes for IM morphine (significant at P＝0.019 comparing IM and IV morphine). No significant difference was seen between groups in patient satisfaction.

CONCLUSION

This emergency room study of patients with moderate to severe orthopedic pain found that intranasal ketamine may have similar efficacy as IM or IV morphine.