February - 2012
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Morphine and Ketamine Is Superior to Morphine Alone for Out-of-Hospital Trauma Analgesia: A Randomized Controlled TrialPaul A. Jennings, Peter Cameron, Stephen Bernard, Tony Walker, Damien Jolley, Mark Fitzgerald, Kevin Masci Annals of Emergency Medicine, 2012, Published on line ahead of print This page is only available to Crit-IQ subscribers. To view the rest of this review and gain access to our vast array of critical care teaching tools including podcasts, vodcasts, modules, exam preparation tools, teaching aids and much more, login here, or Become a Member to register |
February |
Previous Comments
| This is a very interesting paper - in my limited experience, ketamine seems to work really well for prehospital analgesia, particularly for painful procedures like ICCs. I guess my main criticism of the paper is that the improved pain relief might be due to more rapid titration against pain, as it was given every 3 minutes rather than every 5 for morphine. Could this explain the difference? | |
| Darren Cable-08 Feb, 2012 08:53:50 PM | |
| The other limitation is the open label nature. If you want to prove ketamine works, you'd give it a bit more and a bit more and with the different dosing interval, its not surprising it comes out on top. I'm not convinced this paper proves anything that we don't already know. | |
| Jo Butler-08 Feb, 2012 08:58:39 PM | |
| Interesting - ketamine certainly seems to be the drug of the moment. I do like it in this situation - an acute painful procedure such as splinting a femur fracture for example. Good way to get the patient under control quickly without the major depression in respiratory status. I heard Scott Weingart talk about using it in DSI (Delayed Sequence Induction - I think he made it up!). He says he gives ketamine to allow for pre-oxygenation. Not a bad idea. | |
| Jean Bridie-19 Feb, 2012 01:30:05 PM | |
Comment
Effective analgesia in unstable trauma patients is a difficult art. This paper compares two propsective strategies, narcotic based analgesia with ketamine, and finds the latter to be effective and well tolerated.