Low Dose Ketamine Versus Morphine for Moderate to Severe Pain in the Emergency Department
Condition: Pain
MeSH terms: Emergencies
Intervention: Morphine; Ketamine
Intervention description: Morphine: 0.1 mg /kg given as IVP; Ketamine:0.3 mg/given as IVP
Intervention MeSH terms: Ketamine; Morphine
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Enrollment: 90.0
Sex: All
Minimum age: 18 Years
Maximum age: 55 Years
Healthy volunteers: Accepts Healthy Volunteers
Keywords: pain; Ketamine; Emergency Medicine; morphine

Summary:

      The primary objectives of the study are to evaluate the efficacy of subdissociative dose
      intravenous ketamine compared with intravenous morphine in relieving acute pain in the ED.
      Secondary objectives will include the rate of adverse effects and need for rescue analgesia.
      The hypothesis is that intravenous administration of subdissociative dose ketamine at 0.3
      mg/kg is superior to intravenous morphine at 0.1mg/kg in treating moderate and severe acute
      pain in patients presenting to the ED.
    

Eligibility criteria:

        Inclusion Criteria:

          1. ED patients18-55 years old presenting with moderate to severe (Numeric Pain Rating
             Score >5) acute (less than 7 days)

          2. abdominal, flank, back or musculoskeletal pain warranting (in the treating physician's
             judgment) administration of intravenous opioid pain medication.

          3. Patients must be awake, alert and oriented to time, place and person,

          4. patient must be able to demonstrate understanding of the informed consent.

          5. Patient must be able to verbalize how much pain they are having on the 10 point
             Numeric Rating Pain Scale,

          6. Patient mus be able to verbalize the nature of the side effects he may be experiencing
             from the intravenous analgesia.

        Exclusion Criteria:

          1. Pregnancy or breast feeding

          2. SBP<90

          3. Weight greater than 115kg or less than 45kg,

          4. altered mental status,

          5. allergy to ketamine or morphine,

          6. history of acute head or ocular trauma

          7. presence of intracranial mass or vascular lesion, presence of psychiatric history

          8. diagnosis or treatment (as assessed by electronic chart review).

          9. history of seizure or intracranial hypertension

         10. history of chronic pain, pain syndrome or fibromyalgia

         11. presence of cardiovascular disease except controlled hypertension

         12. history of acute head or ocular trauma, drug or alcohol abuse in the preceding 6
             months

         13. drugs or alcohol abuse in the preceding 6 months

         14. SBP>180

         15. HR<50

         16. HR>150

         17. RR<10

         18. RR>30

         19. administration of opiate pain medication in the past 4 hours prior to assessment (i.e.
             home, EMS, triage, office, etc.)

         20. presence of renal or hepatic insufficiency (as assessed by electronic chart review),