Ketamine a viable alternative to morphine for out-of-hospital traumatic pain

Ketamine is noninferior to morphine in terms of providing pain relief in patients with out-of-hospital traumatic pain, according to the results of the KETAMORPH* study.

KETAMORPH included 251 adult patients (median age 51 years, 44.9 percent women) with out-of-hospital trauma and a verbal rating scale pain score of at least 5. These patients were randomly assigned to receive intravenous infusion of either ketamine hydrochloride (20 mg, followed by 10 mg every 5 minutes; n=128) or morphine sulfate (2 or 3 mg every 5 minutes; n=123).

Thirty minutes following treatment administration, the primary outcome of verbal rating scale pain scores decreased by 3.6 (95 percent confidence interval [CI], −5.0 to −2.0) in the ketamine group and by 3.8 (95 percent CI, −5.0 to −2.0) in the morphine group (difference, 0.2, 95 percent CI, −0.5 to 0.9), establishing the noninferiority of ketamine.

Vital signs did not significantly differ between the two treatment groups.

Adverse events occurred in 40.8 percent of patients in the ketamine group and in 16.8 percent of those in the morphine group. The most frequent adverse events were emergence phenomena and nausea in the respective groups. None of the adverse events required intervention.

The findings highlight the potential of ketamine as an alternative to opioids, especially in the face of an opioid crisis.

*Intravenous Subdissociative-Dose Ketamine Versus Morphine for Prehospital Analgesia