Clinical trial comparison of analgesic effect of morphine along with different doses of ketamine and prescription of morphine alone for controlling pain in trauma patients

Abstract

Introduction: Effective pain control with minimal side effects is one of the most important tasks of emergency physicians in trauma patients. In this randomized clinical trial, the effect of low doses of ketamine in trauma patients with moderate to severe pain were compared with morphine sulfate. Materials and Methods: This double-blind clinical trial study was conducted in three academic hospitals. Trauma patients (acute limb trauma) over 18 years old with moderate to severe pain (VAS≥5) were assigned into three groups: Group A received 0.1 mg/kg morphine plus 2 cc normal saline as a placebo. Group B received the same dose Morphine sulfate in addition to Ketamine 0.15mg/kg and group C received morphine plus Ketamine 0.3 mg/kg. Patient's pain was recorded based on VAS system at pre-injection and 15, 30, 60, 120, 90, 150 and 180 times after injection. Results: A total of 187 people participated in the study. Pain score was decreased more rapidly and effectively in group C compared to A and B (P<0.001). Need for repeated morphine doses for pain control was higher in group A at 15 and 30 min after injection of first dose (p<0.001). Dysphoria was higher in group C (p<0.001) and nausea occurred significantly more frequent in group A (p=0.004). Conclusion: Results of the present study are similar to other studies in this field and we can conclude that adding of ketamine to morphine decreases pain more effectively and rapidly and also decreases the need for repeated morphine injection. It is hoped that in the near future this drug can be used as one of the usual treatments for moderate to severe pains in the presence of opiate or even alone in the emergency room.