Low Dose Ketamine vs Morphine for Acute Pain

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Written by Clay Smith

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Low-dose ketamine IV was the same as morphine IV for pain control <60 minutes, while morphine may be superior > 60 minutes. Both had similar rates of nausea and hypoxia.

Why does this matter?
A very similar meta-analysis in 2017 included three RCTs. This one is larger and includes these three plus five more new trials. How does ketamine perform at low dose for pain?

Ketamine or morphine – you pick
This was a systematic review and meta-analysis of 8 RCTs, 1,191 patients, who received either low dose ketamine IV (0.2-0.5mg/kg, most often 0.3mg/kg) or morphine IV (0.1mg/kg) in the ED for acute pain. There was no difference in pain control at 15, 30, 45, or 60 minutes. Morphine was a little better when pain score was measured at over 60 minutes, but this was based predominately on the results of one study. Rescue doses were also the same for both. There was no difference in adverse outcomes of nausea or hypoxia. One included study was a non-peer reviewed abstract. Overall certainty of evidence was low.

Source
Low-dose ketamine for acute pain control in the emergency department: A systematic review and meta-analysis. Acad Emerg Med. 2020 Oct 24. doi: 10.1111/acem.14159. Online ahead of print.

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