Low-dose Ketamine for Acute Pain in the Emergency Department

Ketamine

Brief Summary

This study aims to determine the efficacy and safety of low dose ketamine in association with IV morphine in the management of acute moderate to severe pain in emergency department. The investigators hypothesize that low dose ketamine will result in more effective pain control than morphine alone and will not be associated with an increase in adverse events.

Intervention / Treatment

  • Ketamine (DRUG)
    ketamine
  • Placebos (DRUG)
    0.9% normal saline
  • Morphine (DRUG)

Condition or Disease

  • Pain

Phase

  • Phase 1

    • Study Design

    Study type: INTERVENTIONAL
    Status: Unknown status
    Study results: No Results Available
    Age: 18 Years to 65 Years
    Enrollment: 125 (ACTUAL)
    Funded by: Other
    Allocation: Randomized
    Primary Purpose: Treatment

    Masking

    TRIPLE:
    • Participant
    • Care Provider
    • Investigator

    Clinical Trial Dates

    Start date: Jan 01, 2016
    Primary Completion: Jun 01, 2016 ACTUAL
    Completion Date: Mar 01, 2017 ESTIMATED
    Study First Posted: Jan 11, 2017 ESTIMATED
    Results First Posted: Aug 31, 2020
    Last Updated: Jan 29, 2017

    Sponsors / Collaborators

    Lead Sponsor: Faculty of Medicine, Sousse
    Responsible Party: N/A

    Location

    Sousse, Tunisia
    Faculty of medicine of Sousse, Sousse, Tunisia

    Management of pain in the Emergency Department is challenging. Treatment of pain is most often accomplished by parenteral opioids analgesics. However, the use of opioids alone for pain control is often associated with inadequate analgesia and increased adverse events.

    Low-dose ketamine has been shown to improve pain perception and produce an opioid-sparing effect when given perioperatively.

    Its use in the ED may probably play a role in maximizing analgesia.

    Participant Groups

    • Morphine IV, Dose: 0.1 mg/Kg followed 10 minutes later by an injection of Placebos (0.9% normal saline 0.05ml/kg)

    • Morphine IV, Dose: 0.1 mg/Kg followed 10 minutes later by an IV bolus of Ketamine at the dose of 0.15mg/kg

    • Morphine IV, Dose: 0.1 mg/Kg followed 10 minutes later by an IV bolus of Ketamine at the dose of 0.3mg/kg

    Eligibility Criteria

    Sex: All
    Minimum Age: 18
    Maximum Age: 65
    Age Groups: Adult / Older Adult
    Healthy Volunteers: Yes

    Inclusion Criteria:

    * Able to understand and give informed consent
    * Comfortable with the experimental protocol as outlined to them by the research team
    * Severe pain, pain score of at least 50/100 on Visual Analogue Scale (VAS) or 5/10 numerical ratings score
    * Acute pain, pain duration \< 7days
    * Deemed by treating ED attending physician to require IV opioid analgesia

    Exclusion Criteria:

    * Neurologic, respiratory, or hemodynamic compromise
    * Pregnancy or breastfeeding
    * Known or suspected allergy to ketamine or morphine
    * Known Renal (Cr\>2.0) or Liver Failure
    * Unstable psychiatric disease (as per treating physician)
    * History of stroke
    * History of cardiac disease or coronary artery disease
    * History of chronic respiratory disease

    Primary Outcomes

    • At baseline, to assess our primary aim, efficacy of pain control, we will use patient reported pain scores and amount of rescue analgesia (parenteral morphine) received. Trained residents will ask participants to report their pains scores using a numerical pain rating scale (NPRS). The NPRS used will be a 0 to 10 rating scale. Baseline NPRS will be measured after randomization, but just before administration of morphine. Change in reported pain score during the protocol will be analysed. The SPID was calculated using the pain-intensity difference (PID) at each of these study time points. The PID for a given time point is equal to the baseline NPRS minus the subsequent NPRS at each study time point. SPID is the summation of the PID at each of the study time points, weighted using the amount of time since the prior assessment

    Secondary Outcomes

    • The total patient-perceived pain relief will be calculated using weighted sum of the pain relief scale performed at each study time point. This pain relief scale is a five-point scale that asks participants to rate pain relief as complete = 4, a lot = 3, some = 2, a little = 1, and none = 0

    • The amount of rescue analgesia received (in milligrams of morphine equivalents) will be recorded.

    • Time to rescue analgesia will be calculated as the time from administration of the last study medication (placebo or ketamine) to administration of an opioid analgesic.

    • We will record participant-reported dizziness, nausea, vomiting, confusion, dysphoria, visual disturbances, or other complaints at baseline and each study time point. All patients will be monitored for the duration of the study period and vital signs will be recorded at each time point. The presence of tachycardia (heart rate \> 100 beats/min.), hypotension (systolic blood pressure \[sBP\] \< 100 mm Hg), hypertension (sBP \> 180 mm Hg or diastolic blood pressure \[dBP\] \> 100 mm Hg), and respiratory depression (respiratory rate \< 12 breaths/min, oxygen saturation \< 92%, or need for supplemental oxygen) will be noted.

    • The amount of rescue analgesia will be recorded at each time point and the total dose calculated

    More Details

    NCT Number: NCT03017248
    Other IDs: FMSousse
    Study URL: https://clinicaltrials.gov/study/NCT03017248
    Last updated: Sep 29, 2023