Ketamine For Acute Treatment of Pain in Emergency Department
Condition: Pain
MeSH terms: Emergencies
Intervention: Ketamine; Placebo
Intervention description: Ketamine 0.3mg/kg in 50ml normal saline, administered over 15 minutes; Normal saline 50ml, administered over 15 minutes
Intervention MeSH terms: Ketamine
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Enrollment: 60.0
Sex: All
Minimum age: 18 Years
Maximum age: 80 Years
Healthy volunteers: No
Keywords: analgesia; ketamine; pain

Summary:

      The aim of the study is to compare the safety & efficacy of low dose ketamine and morphine
      versus morphine alone for acute generalized pain in the Emergency Department (ED). The
      investigators are also interested to investigate whether low-dose ketamine is a safe and
      effective alternative option to opioids for the acute treatment of pain in the Emergency
      Department.

      The agents that are available in the department includes acetaminophen, non-steroidal
      anti-inflammatory (NSAIDS) and opioids. In most cases, acetaminophen and NSAIDS are not
      adequate to manage acute pain crisis. There is also heightening concerns for increased opioid
      use or abuse by patients. Since the HCAPHS survey includes various questions which inquires
      about patient perception of pain management in the department, the investigators are
      interested in investigating the safety and efficacy of low-dose ketamine to as an alternative
      method to opioids for the acute management of pain. There has been limited, mostly
      observational pilot studies, published in the literature. Limited data in the literature have
      reported the incidence of nausea and vomiting ranged from 3-13%. All published literature
      administered low-dose ketamine as an intravenous push. To the best of our knowledge our study
      would be the first study to administer low-dose ketamine as a short bolus infusion to
      mitigate the incidence of nausea and vomiting. The investigators believe our study would
      provide important scientific data to fill the theoretical gap that low-dose ketamine at
      0.3mg/kg/dose may be a safe and effective agent for acute pain management in an ED that is
      located in the center of a densely populated urban area.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Patients 18 years old and older presenting with acute generalized pain

          -  Describes pain to be greater than or equal to 3 on the Visual Analogue Scale (VAS)

          -  Provides informed consent

        Exclusion Criteria:

          -  Patients who are admitted to the hospital

          -  Severe hypertension(≥180/100)

          -  Presence of or suspected for traumatic head injury with or without loss of
             consciousness

          -  Presence of or suspected for myocardial ischemia

          -  Presence of or suspected alcohol intoxication

          -  Hemodynamic instability

          -  History of schizophrenia

          -  History of Sickle cell crisis / presenting with acute sickle cell crisis

          -  History of or suspected recreational substance abuse

          -  History of or suspected diagnosis of headache or migraine

          -  History of or suspected diagnosis increase in intracranial/intraocular pressure

          -  Known or suspected pregnancy

          -  Allergy to ketamine or morphine

          -  Administration of opioids in previous 4 hours

          -  Patients with language barriers or in altered mental status who are unable to describe
             pain

          -  Patients weighing over 166kg