• 
• 

Three Part Question

In [conscious adult trauma patients with a femur fracture that are treated by Paramedics] is [administering analgesic doses of IV Ketamine more effective than IV Morphine] at [reducing pain and distress prior to the application of a Kendrick Traction Device]?

Clinical Scenario

A 25 y/o male has sustained a femur fracture and is attended by Paramedics. I know IV Morphine will reduce pain and distress to facilitate the application of a Kendrick Traction Device, but will analgesic doses of IV Ketamine achieve this quicker?

Search Strategy

MEDLINE EBSCOhost 2011-23

([Adult limb trauma] AND [Ketamine] OR [Morphine]) AND [severe pain] AND [pre hospital or paramedic or ambulance] NOT [children or sedation])

Search Outcome

20 papers, 16 were irrelevant, 3 was non specific for ketamine vs morphine, 3 papers are listed below.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses

Comment(s)

Pain is a common presenting complaint and there is considerable debate regarding the best practice for analgesia in the pre-hospital environment for trauma patients with severe pain. Ketamine is an anaesthesia drug with analgesic properties at sub anaesthetic doses, that has been used extensively in trauma. Galinski et al.found that the visual analogue scale pain measure was not statistically different between the morphine and ketamine intervention group and the morphine alone control group. Therefore, I would suggest that with onset time of 3-25 mins for ketamine and and onset time of 15-20 mins, Ketamine will reduce pain faster but is no mor effective thank morphine at reducing pain scores in adults.

Clinical Bottom Line

From the overall results recommendations could be made for practice. Ketamine when administered in analgesic (sub-anaesthetic) doses [0.1–0.5mg/kg intravenously] appears at least as effective or more effective than an opioid alone at reducing pain intensity in the pre-hospital with less side effect than morphine. Ketamine could be administered safely by Paramedics with additional training.

References

1. Jennings et al Ketamine as an analgesic in the pre-hospital setting: a systematic review Wiley 2011; 6
2. Friesgaard et al Opioids for Treatment of Pre-hospital Acute Pain: A Systematic Review 2022; 20
3. x x