Ketamine vs Morphine for pre hospital pain management in trauma
Date First Published:
January 3, 2024
Last Updated:
December 2, 2024
Report by:
Phil Webster, Paramedic (Manchester Metropolitan University)
Three-Part Question:
In [conscious adult trauma patients with a femur fracture that are treated by Paramedics] is [administering analgesic doses of IV Ketamine more effective than IV Morphine] at [reducing pain and distress prior to the application of a Kendrick Traction Device]?
Clinical Scenario:
A 25 y/o male has sustained a femur fracture and is attended by Paramedics. I know IV Morphine will reduce pain and distress to facilitate the application of a Kendrick Traction Device, but will analgesic doses of IV Ketamine achieve this quicker?
Search Strategy:
MEDLINE EBSCOhost 2011-23
Search Details:
([Adult limb trauma] AND [Ketamine] OR [Morphine]) AND [severe pain] AND [pre hospital or paramedic or ambulance] NOT [children or sedation])
Outcome:
20 papers, 16 were irrelevant, 3 was non specific for ketamine vs morphine, 3 papers are listed below.
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Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Ketamine as an analgesic in the pre-hospital setting: a systematic review Jennings et al 2011 Australia | This systematic review considered all English-language publications that reported on patients presenting with pain and managed in the pre-hospital environment. |
Systematic Review | Low number of papers reviewed out of 837 searched. Low number of patients of 164 | ||
| Opioids for Treatment of Pre-hospital Acute Pain: A Systematic Review Friesgaard et al 2022 | 112 studies included of | Systematic Review | Although a large number of papers was screened, studies on pre-hospital opioid administration to relieve acute pain is scarce and overall quality of evidence is low. |
||
| x x 2017 Germany | From 685 publications, 624 were excluded leaving 41 for analysis. | Systematic Review and Meta Analysis | The review and meta-analysis focuses on the analgesics most commonly used in Germany, wide ranging literature. |
Author Commentary:
Pain is a common presenting complaint and
there is considerable debate regarding the best practice for analgesia in the pre-hospital environment for trauma patients with severe pain. Ketamine is an anaesthesia drug with analgesic properties at sub anaesthetic doses, that has been used extensively in trauma. Galinski et al.found that the visual analogue scale pain measure was not statistically different
between the morphine and ketamine intervention
group and the morphine alone control group. Therefore, I would suggest that with onset time of 3-25 mins for ketamine and and onset time of 15-20 mins, Ketamine will reduce pain faster but is no mor effective thank morphine at reducing pain scores in adults.
there is considerable debate regarding the best practice for analgesia in the pre-hospital environment for trauma patients with severe pain. Ketamine is an anaesthesia drug with analgesic properties at sub anaesthetic doses, that has been used extensively in trauma. Galinski et al.found that the visual analogue scale pain measure was not statistically different
between the morphine and ketamine intervention
group and the morphine alone control group. Therefore, I would suggest that with onset time of 3-25 mins for ketamine and and onset time of 15-20 mins, Ketamine will reduce pain faster but is no mor effective thank morphine at reducing pain scores in adults.
Bottom Line:
From the overall results recommendations could be made for practice.
Ketamine when administered in analgesic
(sub-anaesthetic) doses [0.1–0.5mg/kg intravenously] appears at least as effective or more
effective than an opioid alone at reducing pain
intensity in the pre-hospital with less side effect than morphine. Ketamine could be administered safely by Paramedics with additional training.
Ketamine when administered in analgesic
(sub-anaesthetic) doses [0.1–0.5mg/kg intravenously] appears at least as effective or more
effective than an opioid alone at reducing pain
intensity in the pre-hospital with less side effect than morphine. Ketamine could be administered safely by Paramedics with additional training.
References:
- Jennings et al. Ketamine as an analgesic in the pre-hospital setting: a systematic review
- Friesgaard et al. Opioids for Treatment of Pre-hospital Acute Pain: A Systematic Review
- x. x