This study aims to determine the efficacy and safety of low dose ketamine in association with IV morphine in the management of acute moderate to severe pain in emergency department. The investigators hypothesize that low dose ketamine will result in more effective pain control than morphine alone and will not be associated with an increase in adverse events.
Management of pain in the Emergency Department is challenging. Treatment of pain is most often accomplished by parenteral opioids analgesics. However, the use of opioids alone for pain control is often associated with inadequate analgesia and increased adverse events. Low-dose ketamine has been shown to improve pain perception and produce an opioid-sparing effect when given perioperatively. Its use in the ED may probably play a role in maximizing analgesia.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
125
Faculty of medicine of Sousse
Sousse, Tunisia
Efficacy of analgesia: To assess the primary outcome of pain relief, we used patient-reported pain scores. We consider the pain decreasing of at least 50% of pain score and the summed pain-intensity difference (SPID) over 2 hours
At baseline, to assess our primary aim, efficacy of pain control, we will use patient reported pain scores and amount of rescue analgesia (parenteral morphine) received. Trained residents will ask participants to report their pains scores using a numerical pain rating scale (NPRS). The NPRS used will be a 0 to 10 rating scale. Baseline NPRS will be measured after randomization, but just before administration of morphine. Change in reported pain score during the protocol will be analysed. The SPID was calculated using the pain-intensity difference (PID) at each of these study time points. The PID for a given time point is equal to the baseline NPRS minus the subsequent NPRS at each study time point. SPID is the summation of the PID at each of the study time points, weighted using the amount of time since the prior assessment
Time frame: Two hours after starting protocol
Total patient-perceived pain relief
The total patient-perceived pain relief will be calculated using weighted sum of the pain relief scale performed at each study time point. This pain relief scale is a five-point scale that asks participants to rate pain relief as complete = 4, a lot = 3, some = 2, a little = 1, and none = 0
Time frame: Two hours after starting protocol
Amount of rescue analgesia received
The amount of rescue analgesia received (in milligrams of morphine equivalents) will be recorded.
Time frame: Two hours after starting protocol
Time to rescue analgesia
Time to rescue analgesia will be calculated as the time from administration of the last study medication (placebo or ketamine) to administration of an opioid analgesic.
Time frame: Two hours after starting protocol
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The occurrence of adverse events
We will record participant-reported dizziness, nausea, vomiting, confusion, dysphoria, visual disturbances, or other complaints at baseline and each study time point. All patients will be monitored for the duration of the study period and vital signs will be recorded at each time point. The presence of tachycardia (heart rate \> 100 beats/min.), hypotension (systolic blood pressure \[sBP\] \< 100 mm Hg), hypertension (sBP \> 180 mm Hg or diastolic blood pressure \[dBP\] \> 100 mm Hg), and respiratory depression (respiratory rate \< 12 breaths/min, oxygen saturation \< 92%, or need for supplemental oxygen) will be noted.
Time frame: Two hours after starting protocol
The total dose of morphine administered
The amount of rescue analgesia will be recorded at each time point and the total dose calculated
Time frame: Two hours after starting protocol