Analgesic Effects of Ketamine Nebulizer vs.Intravenous Morphine in Limb Trauma Patients in Pre-Hospital Emergency Setting;A Randomized Double-Blinded Clinical Trial

Background: Limb trauma is one the main causes of emergency room (ER) referrals and patients often complain of pain from the very moment of arrival.Objective: We decided to compare the analgesic effect of ketamine nebulizer with intravenous (IV) morphine in trauma patients referred to ER.Methods: In this clinical trial study trauma patients referred to ER of Alzahra and Kashani hospitals in Isfahan, Iran were selected. All trauma patients older than ۱۸ years with limb pain ۷ ^were included. During pre-hospital management, patients were divided into two groups of receiving ketamine nebulizer with a dose of ۱.۶ mg/kg and receiving IV morphine with a dose of ۰.۱ mg/kg. Pain score, vital signs and complications were recorded ۵ and ۱۵ minutes after receiving the first dose of drug and also at the time of arrival to ER.Results: Finally, the records of ۳۹۱ patients were analysed. There was no significant difference between the two groups in terms of pain intensity, vital signs before intervention, the first ۵ and ۱۵ minutes after and the time of arrival in ER (P>۰.۰۵). But the changing of VAS scores in different times was significant in both groups (P<۰.۰۰۱). There was a significant difference between the two groups in complications including nausea and vomiting (P<۰.۰۰۱), and also delirium (P=۰.۰۱۰).Conclusion: Using ketamine nebulizer can produce similar analgesic effects as IV morphine in trauma patients referred to ER.

Keywords:

Emergency Medical Services , Ketamine , Morphine , Pain Management , Trauma