Low Dose Ketamine (LDK) Versus Morphine for Acute Pain Control in the Emergency Department
Condition: Abdomen, Acute; Other Acute Pain; Flank Pain; Back Pain; Musculoskeletal Pain
MeSH terms: Musculoskeletal Pain; Emergencies; Acute Pain; Abdomen, Acute; Flank Pain
Study type: Interventional
Phase: Phase 4

Summary: 
      The purpose of this study is to compare the safety and effectiveness of intravenous low dose
      ketamine (LDK) to the industry standard of morphine (MOR) in regards to controlling acute
      pain in the emergency department.

      Both LDK and morphine have side effects. The amount and character of these side effects will
      be compared. Additionally, the degree of sedation or agitation will be specifically measured.
      The aim of this current study is to make this comparison and shift the evidence for LDK use
      from the anecdotal to the scientific.
    

Detailed description: 
      Phase 1 is a randomized, controlled, double-blinded study comparing the use of low-dose
      ketamine (LDK) to morphine for acute pain control in emergency department patients. A
      convenience sample of subjects will be enrolled from a population of patients aged 18-50 who
      present to the Brooke Army Medical Center Emergency Department with acute abdominal pain,
      flank/lumbar back pain and/or pain to the extremities. To take part in the study, a need for
      opioid analgesia must be indicated by the treating physician in addition to the patient
      meeting all other study criteria.

      The patient will then be randomized into one of the two treatment arms. Prior to receiving
      either the study medication (ketamine) or the active control (morphine) the patient will be
      asked to rate their pain on a numeric rating scale (NRS) with 0 being no pain and 10 being
      the worst pain possible. Their baseline vital signs (blood pressure, heart rate, respiratory
      rate and oxygen saturation) will also be documented. These vital signs and the NRS will be
      reassessed at 5, 10 and 20 minutes post medication dosage. At 20 minutes they will also
      document a Richmond Agitation Sedation Scale (RASS) score and will ask the patient if they
      require additional pain medication. If the patient denies the need for a second dose of
      medication they will continue to be re-assessed every 20 minutes (vital signs, NRS, and RASS)
      until either inpatient admission, discharge home, transfer to the operating room or until a
      total of 120 minutes after initial dosing.

      If at any time during the study the patient requires a second dose of pain medication,
      following the administration of the med, they will be assessed for vital signs at 5,10 and 20
      minutes after the dose. At 20 minutes, a RASS score and NRS score will also be documented.
      They will then be re-assessed every 20 minutes (vital signs, NRS, and RASS) until either
      inpatient admission, discharge home, transfer to the operating room or until a total of 120
      minutes after initial dosing.

      If they require a third dose of pain medication at any time during the study, this is
      considered a treatment failure and the treating physician will be contacted to provide any
      further pain control.

      The second phase of the study will be observational. An anonymous satisfaction survey will be
      provided to the treating nurse, physician or physicians assistant (PA) of the patients
      recruited from part one of the study. The purpose of conducting the survey is so that an
      observation point of view can be added to the data to provide a measure of how well the
      patient's pain was controlled.
    

Intervention name(s): Ketamine; Morphine
Intervention type(s): Drug; Drug
Intervention description(s): 0.3 mg/kg ketamine Intravenous push (IVP) over 5 minutes. Total of two possible doses.; 0.1 mg/kg Morphine IVP over 5 minutes. Total of two possible doses.
Other intervention name(s): Ketalar; MS Contin; Roxanol; Kadian; Avinza
Intervention MeSH terms: Ketamine; Morphine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary purpose: Treatment
Keywords: Pain; Emergency Department; Morphine; Ketamine