Low-dose ketamine as an adjunct to morphine: A randomized controlled trial among patients with and without current opioid use.

IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE Academic Emergency Medicine Pub Date : 2024-10-01 Epub Date: 2024-07-16 DOI:10.1111/acem.14983
Stine Fjendbo Galili, Bodil Hammer Bech, Hans Kirkegaard, Jette Ahrensberg, Lone Nikolajsen
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Abstract

Background: Pain is a common complaint among patients presenting to the emergency department (ED), yet pain treatment is frequently suboptimal. The aim of this study was to determine the effectiveness of low-dose ketamine (LDK) as an adjunct to morphine versus morphine alone for treatment of acute pain among ED patients with and without current opioid use.

Methods: Adult patients presenting with acute pain of ≥5 on a numeric rating scale (0-10) who were deemed by their treating ED physician to require intravenous opioids were randomized to receive either 0.1 mg/kg ketamine (treatment group) or isotonic saline (placebo) as an adjunct to morphine. Patients with and without current opioid use were randomized separately. Pain was measured at baseline (T0) and 10, 20, 30, 45, 60, and 120 min after randomization. The primary outcome was pain reduction from T0 to T10. Secondary outcomes included pain intensity over 120 min, need of rescue opioids, side effects, and patient and provider satisfaction.

Results: A total of 116 patients were included from May 2022 to August 2023. Median (IQR) age was 51 (36.5-67) years; 58% were male and 36% had current opioid use. Pain reduction from T0 to T10 was greater in the LDK group (4 [IQR 3-6]) compared to the placebo group (1 [IQR 0-2]; p = 0.001). Pain intensity was lower in the LDK group at T10, T20, and T30, compared to the placebo group. There was a higher risk of nausea, vomiting, and dissociation in the LDK group during the first 10 min.

Conclusions: LDK may be effective as an adjunct analgesic to morphine for short-term pain relief in treatment of acute pain in the ED for both patients with and without current opioid use.

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小剂量氯胺酮作为吗啡的辅助药物:在目前使用和未使用阿片类药物的患者中进行的随机对照试验。
背景:疼痛是急诊科(ED)患者的常见主诉,但疼痛治疗效果往往不尽如人意。本研究旨在确定低剂量氯胺酮(LDK)作为吗啡的辅助药物与单独使用吗啡治疗目前使用或未使用阿片类药物的急诊科患者急性疼痛的效果:对急诊科医生认为需要静脉注射阿片类药物的急性疼痛评分≥5分(0-10分)的成人患者进行随机分组,接受0.1毫克/千克氯胺酮(治疗组)或等渗盐水(安慰剂)作为吗啡的辅助治疗。正在使用和未使用阿片类药物的患者被分别随机分组。疼痛测量时间为基线(T0)和随机分组后的 10、20、30、45、60 和 120 分钟。主要结果是从 T0 到 T10 的疼痛减轻情况。次要结果包括 120 分钟内的疼痛强度、阿片类药物救援需求、副作用以及患者和提供者的满意度:结果:从 2022 年 5 月到 2023 年 8 月,共纳入 116 名患者。中位(IQR)年龄为 51(36.5-67)岁;58% 为男性,36% 目前使用阿片类药物。与安慰剂组(1 [IQR 0-2];p = 0.001)相比,LDK 组从 T0 到 T10 的疼痛减轻幅度更大(4 [IQR 3-6])。与安慰剂组相比,LDK 组在 T10、T20 和 T30 的疼痛强度较低。在最初的 10 分钟内,LDK 组出现恶心、呕吐和分离的风险较高:LDK可作为吗啡的辅助镇痛药,在急诊室治疗急性疼痛时有效缓解疼痛,适用于目前使用或未使用阿片类药物的患者。
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来源期刊
Academic Emergency Medicine
Academic Emergency Medicine 医学-急救医学
CiteScore
7.60
自引率
6.80%
发文量
207
审稿时长
3-8 weeks
期刊介绍: Academic Emergency Medicine (AEM) is the official monthly publication of the Society for Academic Emergency Medicine (SAEM) and publishes information relevant to the practice, educational advancements, and investigation of emergency medicine. It is the second-largest peer-reviewed scientific journal in the specialty of emergency medicine. The goal of AEM is to advance the science, education, and clinical practice of emergency medicine, to serve as a voice for the academic emergency medicine community, and to promote SAEM''s goals and objectives. Members and non-members worldwide depend on this journal for translational medicine relevant to emergency medicine, as well as for clinical news, case studies and more. Each issue contains information relevant to the research, educational advancements, and practice in emergency medicine. Subject matter is diverse, including preclinical studies, clinical topics, health policy, and educational methods. The research of SAEM members contributes significantly to the scientific content and development of the journal.
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