Comparative safety and efficacy of low dose ketamine and opioids for acute pain management at the emergency department

  • Syed Jehanzeb Asim Department of Emergency Medicine, Dr. Ziauddin Hospital, Karachi
  • Mohammed Aqil Department of Emergency Medicine, Dr. Ziauddin Hospital, Karachi
  • Wajahat Ali Department of Emergency Medicine, Dr. Ziauddin Hospital, Karachi
  • Lal Shehbaz Department of Emergency Medicine, Dr. Ziauddin Hospital, Karachi
  • Shua Nasir Department of Emergency Medicine, Dr. Ziauddin Hospital, Karachi
Keywords: Low Dose Ketamine, Opioid Analgesic, Analgesic, Acute Pain, Oxygen Saturation

Abstract

Background: Pain is a complex phenomenon for which many pharmacological agents have been discovered and utilized for pain relief. Ketamine is a more preferred pain reliever over opioids in the emergency department (ED). The aim of this study was to compare the safety and efficacy of low dose ketamine (LDK) with morphine (opioid) for pain relief among patients presenting to the ED.

Methodology: A prospective, cohort study was conducted over a sample of 280 patients presented with acute pain to the ED, Ziauddin University Hospital, Karachi. These patients were then divided into two groups via simple random sampling with randomization being assured using an online randomizer software tool. The 1st group (n=140) was given 0.2 mg/kg of LDK while 0.1 mg/kg of intravenous morphine (opioid) was given to the 2nd group (n=140). The pain intensity was measured using the Visual Analogue Scale (VAS) from admission to 60 mins, the records were taken after every 15 mins. The adverse events (AE’s) were also recorded for both groups. The data was then analyzed using SPSS Version 21 & Microsoft Excel 2016.

Results: Out of 280 patients enrolled in the study, there was male majority i.e. 76.07% while the remaining were females with the mean age of 29±7 years. Within 15 minutes of initial dose administration in both groups, a marked reduction in pain intensity was observed. Reduced respiratory rate, pruritus and decreased O2 saturation were common AE’s observed, which were comparatively higher among patients receiving morphine as compared to ketamine.

Conclusion: The efficacy of morphine (opium) and LDK is similar in alleviating pain in an emergency setting, however, LDK is visibly safer than its opioid counterpart and thus may be used as a safer alternative.

Downloads

Download data is not yet available.

References

1. Pierik JG, IJzerman MJ, Gaakeer MI, Vollenbroek-Hutten MM, Doggen CJ. Painful discrimination in the emergency department: risk factors for underassessment of patients’ pain by nurses. J Emerg Nurs. 2017;43(3):228-238.
2. Krauss BS, Calligaris L, Green SM, Barbi E. Current concepts in management of pain in children in the emergency department. The Lancet. 2016;387(10013):83-92.
3. Pace C, Shah S, Zhang AX, Zosel AE. Impact of a chronic pain management pathway on opioid administration and prescribing in an Emergency Department. Clin Toxicol. 2018;56(8):744-750.
4. Hansen RN, Pham AT, Böing EA, Lovelace B, Wan GJ, Miller TE. Comparative analysis of length of stay, hospitalization costs, opioid use, and discharge status among spine surgery patients with postoperative pain management including intravenous versus oral acetaminophen. Curr Med Res Opin. 2017; 33(5):943-948.
5. Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, Carter T, Cassidy CL, Chittenden EH, Degenhardt E, Griffith S. Management of Postoperative Pain: a clinical practice guideline from the American pain society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' committee on regional anesthesia, executive committee, and administrative council. J Pain. 2016;17(2):131-157.
Published
2019-12-01
How to Cite
Asim, S. J., Aqil, M., Ali, W., Shehbaz, L., & Nasir, S. (2019). Comparative safety and efficacy of low dose ketamine and opioids for acute pain management at the emergency department. International Journal of Endorsing Health Science Research (IJEHSR), 7(4), 172-178. Retrieved from http://aeirc-edu.com/ojs14/index.php/IJEHSR/article/view/279