EBQ:Subdissociative ketamine vs morphine for analgesia - Revision history

Elcatracho: /* Conclusion */

2021-02-11T18:49:04Z

Conclusion

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	==Conclusion==		==Conclusion==
	Subdissociative intravenous ketamine provides analgesic effectiveness and may be as safe as morphine in the emergency department but does cause patients to complain of disorientation, dizziness, and mood changes.		Subdissociative intravenous ketamine provides analgesic effectiveness and may be as safe as morphine in the emergency department, but does cause patients to complain of disorientation, dizziness, and mood changes.

	==Major Points==		==Major Points==
	[[Ketamine]], a dissociative analgesic can be used for both acute pain relief and procedural sedation. At lower doses (0.1-0.3mg/kg) produces only analgesic effects with minimal to no dissociation<ref>Galinski MM, Dolveck FM, Combes XM, et al. Management of severe acute pain in emergency settings: ketamine reduces morphine consumption. Am J Emerg Med. 2007;25:385-390.</ref><ref>Smith D, Mader T, Smithline H. Low dose intravenous ketamine as an analgesic: a pilot study using an experimental model of acute pain. Am J Emerg Med. 2001;19:531-532</ref> Studies have also shown that ketamine has significant analgesic properties at sub-dissociative doses.<ref>Jennings PP, Cameron PM, Bernard SM, et al. Morphine and ketamine		[[Ketamine]], a dissociative analgesic can be used for both acute pain relief and procedural sedation. At lower doses (0.1-0.3mg/kg) produces only analgesic effects with minimal to no dissociation<ref>Galinski MM, Dolveck FM, Combes XM, et al. Management of severe acute pain in emergency settings: ketamine reduces morphine consumption. Am J Emerg Med. 2007;25:385-390.</ref><ref>Smith D, Mader T, Smithline H. Low dose intravenous ketamine as an analgesic: a pilot study using an experimental model of acute pain. Am J Emerg Med. 2001;19:531-532</ref> Studies have also shown that ketamine has significant analgesic properties at sub-dissociative doses.<ref>Jennings PP, Cameron PM, Bernard SM, et al. Morphine and ketamine

Elcatracho: /* Criticisms & Further Discussion */

2021-02-11T18:48:18Z

Criticisms & Further Discussion

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	==Criticisms & Further Discussion==		==Criticisms & Further Discussion==
	*This study describes the use of ketamine in the emergency department and provides preliminary data for a multi-centered study.		*This study describes the use of ketamine in the emergency department and provides preliminary data for a multi-centered study.
	*~~Kemaine~~ may over similar analgesia at 30 min but does cause greater frequency of dizziness, mood changes and disorientation when compared to morphine. Although these side effects are not life threatening, proper explanation of ketamine should be given to the patient prior to administration due to the greater frequency when compared to morphine.		*Ketamine may over similar analgesia at 30 min but does cause greater frequency of dizziness, mood changes and disorientation when compared to morphine. Although these side effects are not life threatening, proper explanation of ketamine should be given to the patient prior to administration due to the greater frequency when compared to morphine.
	*There are significant exclusions for this study, as in any randomized trial and abstraction of the study to excluded patients is not possible		*There are significant exclusions for this study, as in any randomized trial and abstraction of the study to excluded patients is not possible

	==External Links==		==External Links==
	*[http://www.emlitofnote.com/2015/04/ketamine-vs-morphine-again.html EM Lit of Note - Ketamine vs Morphine, Again]		*[http://www.emlitofnote.com/2015/04/ketamine-vs-morphine-again.html EM Lit of Note - Ketamine vs Morphine, Again]

Ostermayer: Text replacement - "Category:Drugs" to "Category:Pharmacology"

2016-03-22T15:53:58Z

Text replacement - "Category:Drugs" to "Category:Pharmacology"

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	<references/>		<references/>

	[[Category:EBQ]] [[Category:~~Drugs~~]]		[[Category:EBQ]] [[Category:Pharmacology]]

Ostermayer at 16:22, 20 February 2016

2016-02-20T16:22:20Z

← Older revision		Revision as of 16:22, 20 February 2016
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	\| fulltexturl= http://www.annemergmed.com/article/S0196-0644(15)00191-2/abstract?cc=y=		\| fulltexturl= http://www.annemergmed.com/article/S0196-0644(15)00191-2/abstract?cc=y=
	\| pdfurl= http://emcrit.org/wp-content/uploads/2014/12/Intravenous-Sub-dissociative-Dose-Ketamine-versus-Morphine-Print.pdf		\| pdfurl= http://emcrit.org/wp-content/uploads/2014/12/Intravenous-Sub-dissociative-Dose-Ketamine-versus-Morphine-Print.pdf
			\| status=Complete
	}}		}}
	==Clinical Question==		==Clinical Question==

Ostermayer: Created page with "{{JC info | title= Intravenous Subdissociative-Dose Ketamine Versus Morphine for Analgesia in the Emergency Department: A Randomized Controlled Trial | abbreviation= | expans..."

2016-02-20T16:21:57Z

Created page with "{{JC info | title= Intravenous Subdissociative-Dose Ketamine Versus Morphine for Analgesia in the Emergency Department: A Randomized Controlled Trial | abbreviation= | expans..."

New page

{{JC info
| title= Intravenous Subdissociative-Dose Ketamine Versus Morphine for Analgesia in the Emergency Department: A Randomized Controlled Trial
| abbreviation=
| expansion=
| published= Sep 2015
| author= Motov S, Rockoff B, et al.
| journal= Ann Emerg Med
| year= 2015
| volume= 66
| issue=3
| pages= 222-229
| pmid= 25817884
| fulltexturl= http://www.annemergmed.com/article/S0196-0644(15)00191-2/abstract?cc=y=
| pdfurl= http://emcrit.org/wp-content/uploads/2014/12/Intravenous-Sub-dissociative-Dose-Ketamine-versus-Morphine-Print.pdf
}}
==Clinical Question==
Is subdissociative-dose ketamine comparable in terms of analgesia to morphine when administered in the emergency department?

==Conclusion==
Subdissociative intravenous ketamine provides analgesic effectiveness and may be as safe as morphine in the emergency department but does cause patients to complain of disorientation, dizziness, and mood changes.
==Major Points==
[[Ketamine]], a dissociative analgesic can be used for both acute pain relief and procedural sedation. At lower doses (0.1-0.3mg/kg) produces only analgesic effects with minimal to no dissociation<ref>Galinski MM, Dolveck FM, Combes XM, et al. Management of severe acute pain in emergency settings: ketamine reduces morphine consumption. Am J Emerg Med. 2007;25:385-390.</ref><ref>Smith D, Mader T, Smithline H. Low dose intravenous ketamine as an analgesic: a pilot study using an experimental model of acute pain. Am J Emerg Med. 2001;19:531-532</ref> Studies have also shown that ketamine has significant analgesic properties at sub-dissociative doses.<ref>Jennings PP, Cameron PM, Bernard SM, et al. Morphine and ketamine
is superior to morphine alone for out-of-hospital trauma analgesia: a randomized controlled trial. Ann Emerg Med. 2012;59:497-503.</ref> The authors of this study, compared in a randomized fashion, the analgesic properties of subdissociative ketamine to morphine, for acute pain control. Pain relief between the ketamine and morphine groups were statistically similar but is associated with greater patient complaints than IV morphine.
==Study Design==
*Randomized controlled supiority trial at a single emergency department (Maimonides Medical Center NY, USA
==Population==
===Patient Demographics===
*Age: 18yo - 55yo
*Female: 29%
*Weight: 76kg
*Systolic BP: 126kg
*Baseline Pain score: 8.6 out of 10 ketamine group, 8.6 out of 10 morphine group
===Inclusion===
*Patients with pain of the abdomen, back, flank or musculoskeletal system that of at least a 5 out of 10 (on a scale from 0 to 10) and necessitating narcotic analgesia per the attending physician.
===Exclusion===
*Pregnancy,
*Breast-feeding
*Altered mental status
*Allergy to morphine or ketamine
*Weight less than 46 kg or greater than 115 kg
*Unstable vital signs defined as:
**Systolic blood pressure <90 or >180 mm Hg
**Pulse rate <50 or >150 beats/min
**Respiration rate <10 or >30 breaths/min
*Medical history of:
**Acute head or eye injury
**Seizure, intracranial hypertension
**Chronic pain
**Renal or hepatic insufficiency,
**Alcohol or drug abuse
**Psychiatric illness
**Recent (4 hours before) opioid use

==Interventions==
*0.3mg/kg Ketamine or 0.1mg/kg of morphine IV
==Outcomes==

===Primary Outcome===
''30 min numeric pain rating for ketamine vs morphine''
*Ketamine: 4.1 (SD ±3.2)
*Morphine: 3.9 (SD ±3.1)
===Secondary Outcomes===
''Pain scores (Ketamine vs Morphine on scale of 1-10)
*15 min: 3.2 v 4.2
*30 min: 3.2 vs 4.2
*60 min 4.8 v 3.4
*90 min: 4.8 v 3.9
*120 min: 3.9 vs 3.7

===Adverse Effects===
''Ketamine v Morphine''
*Dizziness:
**15 min: 53% v 31%
**30 min: 8% v 6%
*Disorientation:
**15 min: 11% v 0%
**30 min: 1% v 0%
*Mood Changes:
*15 min: 11% v 0%
*30 min: 1% v 0%
*Nausea
*15 min: 18% v 11%
*30 min: 6% v 9%
==Criticisms & Further Discussion==
*This study describes the use of ketamine in the emergency department and provides preliminary data for a multi-centered study.
*Kemaine may over similar analgesia at 30 min but does cause greater frequency of dizziness, mood changes and disorientation when compared to morphine. Although these side effects are not life threatening, proper explanation of ketamine should be given to the patient prior to administration due to the greater frequency when compared to morphine.
*There are significant exclusions for this study, as in any randomized trial and abstraction of the study to excluded patients is not possible
==External Links==
*[http://www.emlitofnote.com/2015/04/ketamine-vs-morphine-again.html EM Lit of Note - Ketamine vs Morphine, Again]
*[http://www.nuemblog.com/blog/ketamine-vs-morphine NUEM Ketamine vs Morphine]]
==See Also==
*[[Ketamine]]
*[[Procedural sedation]]
==Funding==
*Funded in part by a grant from the New York Department of Health’s Empire Clinical Research Investigator Program
==References==
<references/>

[[Category:EBQ]] [[Category:Drugs]]