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
Intervention: Ketamine; Morphine
Intervention description: 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.
Intervention MeSH terms: Ketamine; Morphine
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Enrollment: 45.0
Sex: All
Minimum age: 18 Years
Maximum age: 59 Years
Healthy volunteers: No
Keywords: Pain; Emergency Department; Morphine; Ketamine

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.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Patients age 18-59 who present to the Brooke Army Medical Center Emergency Department
             with acute (less than 10 days) abdominal pain, flank/lumbar back pain and or/pain to
             the extremities, and of sufficient severity in the judgement of the ED treating
             physician or PA to warrant use of intravenous opioids

        Exclusion Criteria:

          -  Poor vital sign stability hypoxia: Sats<95% hypotension: SBP<90 hypertension: SBP>180
             heart rate: <50 or >120 respiratory rate: <10 or >30

          -  Altered mental status or intoxication

          -  Patient is unwilling to participate or provide informed consent

          -  History of chronic pain or pain syndrome with concurrent opioid medication use

          -  fibromyalgia

          -  Patient has received opioids and/or tramadol in the past 4 hours

          -  Prescription pain medication use (to exclude muscle relaxants, acetaminophen or NSAIDs
             including toradol) in the past 4 hours

          -  Allergy to morphine or ketamine

          -  Sole provider status

          -  Adverse reaction to morphine or ketamine in the past

          -  Patients, who in the opinion of the triage nurse, require immediate analgesic relief

          -  Patient is female of child-bearing age and unable to provide urine or serum for HCG
             analysis in triage

          -  Pregnancy or breast feeding

          -  Presence of oxygen dependent pulmonary disease, liver cirrhosis or Renal disease
             requiring dialysis. (as assessed by electronic chart review)

          -  Presence of Ischemic heart disease, heart failure or unstable dysrhythmias (as
             assessed by electronic chart review)

          -  Presence of intracranial mass or vascular lesion.

          -  Presence of psychosis or hallucinations

          -  Weight greater than 115kg or less than 45 kg

          -  History of acute ocular/head trauma

          -  History of increased intracranial pressure/hypertensive hydrocephalus

          -  Non-English speaking patients