KETAMORPH
Trial question
Is ketamine noninferior to morphine in patients with out-of-hospital traumatic pain?
Study design
Multi-center
Single blinded
RCT
Population
Characteristics of study participants
44.0% female
56.0% male
N = 251
251 patients (111 female, 140 male).
Inclusion criteria: adult patients with out-of-hospital traumatic pain and a verbal pain score ≥ 5.
Key exclusion criteria: unstable vital signs; pregnancy; unable to rate their pain with the verbal NRS scores; allergy to morphine or ketamine; acute pulmonary edema or acute HF; acute coronary syndrome or unstable ischemic heart disease; renal or hepatic insufficiency.
Interventions
N=128 ketamine (intravenous push of 20 mg for 2 minutes followed by intravenous push of 10 mg every 5 minutes).
N=123 morphine (intravenous push of 2 mg for patient's < 60 kg or 3 mg for patient's ≥ 60 kg every 5 minutes).
Primary outcome
Mean reduction in pain score between drug administration and 30 minutes later
3.7 points
3.8 points
3.8 points
2.8 points
1.9 points
0.9 points
0.0 points
Ketamine
Morphine
Difference not exceeding
non-inferiority
margin ✓
Difference not exceeding non-inferiority margin in mean reduction in pain score between drug administration and 30 minutes later (3.7 points vs. 3.8 points; AD -0.1 points, 95% CI -0.9 to 0.7).
Secondary outcomes
Significantly greater reduction in pain intensity (0.09 pain points/minute vs. 0.07 pain points/minute; AD 0.02 pain points/minute, 95% CI 0.01 to 0.04).
No significant difference in mean pain score reduction between drug administration and 45 minutes later (4.5 points vs. 5 points; AD -0.5 points, 95% CI -1.04 to 0.04).
No significant difference in incidence of rescue analgesia (4.2% vs. 3.5%; AD 0.6%, 95% CI -0.4 to 5.6).
Safety outcomes
No significant difference in adverse events after 30 minutes of out-of-hospital pain management.
Conclusion
In adult patients with out-of-hospital traumatic pain and a verbal pain score ≥ 5, ketamine was noninferior to morphine with respect to mean reduction in pain score between drug administration and 30 minutes later.
Reference
Clément Le Cornec, Marion Le Pottier, Hélène Broch et al. Ketamine Compared With Morphine for Out-of-Hospital Analgesia for Patients With Traumatic Pain: A Randomized Clinical Trial. JAMA Netw Open. 2024 Jan 2;7(1):e2352844.
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