Ketamine Emerges as Noninferior Alternative to Morphine for Out-of-Hospital Traumatic Pain
In the midst of the opioid crisis, a recent study, the Intravenous Subdissociative-Dose Ketamine Versus Morphine for Prehospital Analgesia (KETAMORPH), has explored the viability of ketamine as an alternative to opioids for managing out-of-hospital traumatic pain. With pain being a prevalent symptom among patients outside healthcare settings, the research aimed to assess the noninferiority of intravenous ketamine compared with intravenous morphine sulfate in providing pain relief for adults facing traumatic pain.
This study was published in the journal of JAMA Network Open by Clement Le and colleagues. The KETAMORPH study, a multicenter, single-blind, noninferiority randomized clinical trial, enrolled 251 adult patients with out-of-hospital trauma and a verbal pain score equal to or greater than 5. These patients were randomly assigned to receive either ketamine (n=128) or morphine (n=123). The primary outcome measured the mean change in verbal rating scale pain scores from before administration to 30 minutes later, with a noninferiority margin of 1.3.
The study revealed that intravenous ketamine was noninferior to intravenous morphine in reducing pain, with no clinically significant differences between the two groups.
The mean pain score change in the ketamine group was -3.7, compared to -3.8 in the morphine group, showcasing the efficacy of ketamine as a pain management option.
Notably, vital signs showed no meaningful differences between the two groups.
While both groups reported adverse effects, the morphine group had 16.8% adverse effects, primarily nausea, compared to 40.8% in the ketamine group, with the emergence phenomenon being the most common.
Importantly, none of the adverse events required intervention.
The KETAMORPH study suggests that intravenous ketamine, administered alone, is a noninferior alternative to morphine for out-of-hospital traumatic pain in adults. This finding holds significant promise amid the ongoing opioid crisis, offering healthcare professionals an effective and safer option for managing acute pain in diverse settings.
Reference:
Le Cornec, C., Le Pottier, M., Broch, H., Marguinaud Tixier, A., Rousseau, E., Laribi, S., Janière, C., Brenckmann, V., Guillerm, A., Deciron, F., Kabbaj, A., Jenvrin, J., Péré, M., & Montassier, E. Ketamine compared with morphine for out-of-hospital analgesia for patients with traumatic pain: A randomized clinical trial. JAMA Network Open,2024;7(1):e2352844. https://doi.org/10.1001/jamanetworkopen.2023.52844
