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Volume 32, Issue 153 (July & August 2024)
J Adv Med Biomed Res 2024, 32(153): 244-252 |
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Partovinezhad E, Ghobadian B, Shiralizadeh S, Partovinezhad H, Hejazi J, Saboory E. Comparison of Efficacy of Nebulized Ketamine plus Lidocaine versus Morphine in Pain Management in Patients referred to Emergency Department: A Randomized triple-blind Clinical Trial. J Adv Med Biomed Res 2024; 32 (153) :244-252
URL: http://journal.zums.ac.ir/article-1-7303-en.html
URL: http://journal.zums.ac.ir/article-1-7303-en.html
Effat Partovinezhad *1 
, Bijan Ghobadian2 , Said Shiralizadeh2 , Hossein Partovinezhad2 , Jalal Hejazi2 , Ehsan Saboory2
, Bijan Ghobadian2 , Said Shiralizadeh2 , Hossein Partovinezhad2 , Jalal Hejazi2 , Ehsan Saboory2
1- Zanjan U of medical sciences , epartovinezhad@zums.ac.ir
2- Zanjan U of medical sciences
2- Zanjan U of medical sciences
Abstract: (498 Views)
Background & Objective: Pain is a common cause of patients referred to the emergency department (ED). The current study was performed to compare the efficacy of ketamine and lidocaine administration instead of intravenous morphine to alleviate acute limb pain in patients.
Materials & Methods: In the current triple-blind clinical trial, 40 included patients were divided into two separate groups. The intervention group received ketamine (5mg/kg), lidocaine (2mg/kg), and normal saline (0.1 ml/kg) intravenously (IV), while the control group received 0.1 mg/kg of morphine and nebulizer normal saline. A 10-point pain scale was performed to measure the pain level and its effects before and after treatment. At intervals of 5-60 minutes, the pain was evaluated.
Results: The average pain relief between the two groups was not statistically different. For the first 5-10 minutes after the drug administration, similar pain relief was observed in both groups. In the first 15 minutes, ketamine and lidocaine nebulizer pain relief was better than morphine. The reaction to pain-relieving medication in both groups was more extensive than the three numerical pain assessments. There was no noticeable adverse effect in the studied groups.
Conclusion: The ketamine and lidocaine nebulizers in emergency departments can be used as a practical and simple approach to managing acute limb pain. Given that lidocaine was utilized in this investigation to boost ketamine mucosal absorption and prevent probable adverse effects, more trials lacking lidocaine could be conducted to remove lidocaine's effect and better evaluate ketamine's effect. Ketamine can also be used at a higher dose to evaluate its effects and possible side effects.
Materials & Methods: In the current triple-blind clinical trial, 40 included patients were divided into two separate groups. The intervention group received ketamine (5mg/kg), lidocaine (2mg/kg), and normal saline (0.1 ml/kg) intravenously (IV), while the control group received 0.1 mg/kg of morphine and nebulizer normal saline. A 10-point pain scale was performed to measure the pain level and its effects before and after treatment. At intervals of 5-60 minutes, the pain was evaluated.
Results: The average pain relief between the two groups was not statistically different. For the first 5-10 minutes after the drug administration, similar pain relief was observed in both groups. In the first 15 minutes, ketamine and lidocaine nebulizer pain relief was better than morphine. The reaction to pain-relieving medication in both groups was more extensive than the three numerical pain assessments. There was no noticeable adverse effect in the studied groups.
Conclusion: The ketamine and lidocaine nebulizers in emergency departments can be used as a practical and simple approach to managing acute limb pain. Given that lidocaine was utilized in this investigation to boost ketamine mucosal absorption and prevent probable adverse effects, more trials lacking lidocaine could be conducted to remove lidocaine's effect and better evaluate ketamine's effect. Ketamine can also be used at a higher dose to evaluate its effects and possible side effects.
Type of Study: Original Research Article |
Subject:
Clinical Medicine
Received: 2023/07/26 | Accepted: 2024/11/3 | Published: 2024/08/20
Received: 2023/07/26 | Accepted: 2024/11/3 | Published: 2024/08/20
References
1. Dale J, Bjørnsen LP. Assessment of pain in a Norwegian Emergency Department. Scand J Trauma Resusc Emerg Med. 2015; 2: 3(1) 1-5. [DOI:10.1186/s13049-015-0166-3] [PMID] []
2. Todd KH. A review of current and emerging approaches to pain management in the emergency department. Pain Ther. 2017; 6(2): 193-202. [DOI:10.1007/s40122-017-0090-5] [PMID] []
3. Hatherley C, Jennings N, Cross R. Time to analgesia and pain score documentation best practice standards for the Emergency Department-A literature review. Australasian Emerg Nurs J. 2016; 19(1): 26-36. [DOI:10.1016/j.aenj.2015.11.001] [PMID]
4. Shill J, Taylor DM, Ngui B, Taylor SE, Ugoni AM, Yeoh M, Richardson J. Factors associated with high levels of patient satisfaction with pain management. Acad Emerg Med. 2012; 19(10): 1212-5. [DOI:10.1111/j.1553-2712.2012.01451.x] [PMID]
5. Bhakta HC, Marco CA. Pain management: association with patient satisfaction among emergency department patients. J Emerg Med. 2014; 46(4): 456-64. [DOI:10.1016/j.jemermed.2013.04.018] [PMID]
6. Hughes JA. Person, environment, and health and illness factors influencing time to first analgesia and patient experience of pain management in the adult emergency department: Queensland University of Technology; 2018.
7. Niesters M, Aarts L, Sarton E, Dahan A. Influence of ketamine and morphine on descending pain modulation in chronic pain patients: a randomized placebo-controlled cross-over proof-of-concept study. Br J Anaesth. 2013; 110(6): 1010-6. [DOI:10.1093/bja/aes578] [PMID]
8. Hedges J, Roberts J. Clinical procedures in emergency medicine. Periton Proced. 1991; 3.
9. Kumar A, Kohli A. Comeback of ketamine: resurfacing facts and dispelling myths. Korean J Anesth. 2021; 74(2): 103. [DOI:10.4097/kja.20663] [PMID] []
10. Parsamanesh N, Karami-Zarandi M, Banach M, Penson PE, Sahebkar A. Effects of statins on myocarditis: a review of underlying molecular mechanisms. Prog Cardiovasc Dis. 2021; 67: 53-64. [DOI:10.1016/j.pcad.2021.02.008] [PMID]
11. Krauss BS, Green SM. Procedural sedation and its place in paediatric emergency medicine. Emerg Med J. 2016 Aug; 33(8): 525-6. [DOI:10.1136/emermed-2016-205743] [PMID]
12. Gyanesh P, Haldar R, Srivastava D, Agrawal PM, Tiwari AK, Singh PK. Comparison between intranasal dexmedetomidine and intranasal ketamine as premedication for procedural sedation in children undergoing MRI: a double-blind, randomized, placebo-controlled trial. J Anesth. 2014; 28(1): 12-8. [DOI:10.1007/s00540-013-1657-x] [PMID]
13. Khutia S, Mandal M, Das S, Basu S. Intravenous infusion of ketamine propofol can be an alternative to intravenous infusion of fentanyl propofol for deep sedation and analgesia in paediatric patients undergoing emergency short surgical procedures. Indian J Anaesth 2012; 56: 145-50. [DOI:10.4103/0019-5049.96313] [PMID] []
14. Riz K, Samir E. Use of ketofol to control emergence agitation in children undergoing adenotonsillectomy. Egypt J Anaesth 2014;30:13 9. 2014; 30: 13-9. [DOI:10.1016/j.egja.2013.09.003]
15. Erdogan MA, Begec Z, Aydogan MS, Ozgul U, Yucel A, Colak C, Durmus M. Comparison of effects of propofol and ketamine-propofol mixture (ketofol) on laryngeal mask airway insertion conditions and hemodynamics in elderly patients: a randomized, prospective, double-blind trial. J Anesth. 2013; 27(1): 12-7. [DOI:10.1007/s00540-012-1484-5] [PMID]
16. Jennings PA, Cameron P, Bernard S, Walker T, Jolley D, Fitzgerald M, Masci K. Morphine and ketamine is superior to morphine alone for out-of-hospital trauma analgesia: a randomized controlled trial. Ann Emerg Med. 2012; 59(6): 497-503. [DOI:10.1016/j.annemergmed.2011.11.012] [PMID]
17. Tsze DS, Steele DW, Machan JT, Akhlaghi F, Linakis JG. Intranasal ketamine for procedural sedation in pediatric laceration repair: a preliminary report. Pediatr Emerg Care. 2012; 28(8): 767-70. [DOI:10.1097/PEC.0b013e3182624935] [PMID]
18. Acworth J, Purdie D, Clark R. Intravenous ketamine plus midazolam is superior to intranasal midazolam for emergency paediatric procedural sedation. Emerg Med J. 2001; 18(1): 39-45. [DOI:10.1136/emj.18.1.39] [PMID] []
19. Cioaca R, Canavea I. Oral transmucosal ketamine: an effective premedication in children. Pediatr Anesth. 1996; 6(5): 361-5. [DOI:10.1046/j.1460-9592.1996.d01-9.x] [PMID]
20. Sokoloff C, Daoust R, Paquet J, Chauny JM. Is adequate pain relief and time to analgesia associated with emergency department length of stay? A retrospective study. BMJ Open. 2014; 4(3): e004288. [DOI:10.1136/bmjopen-2013-004288] [PMID] []
21. Ahuja V, Mitra S, Sarna R. Nebulized ketamine decreases incidence and severity of post-operative sore throat. Indian J Anaesth. 2015; 59(1): 37. [DOI:10.4103/0019-5049.149448] [PMID] []
22. Goyal S, Agrawal A. Ketamine in status asthmaticus: a review. Indian J Crit Care Med. 2013; 17(3): 154. [DOI:10.4103/0972-5229.117048] [PMID] []
23. Thomas D, Bejoy R, Zabrin N, Beevi S. Preoperative ketamine nebulization attenuates the incidence and severity of postoperative sore throat: A randomized controlled clinical trial. Saudi J Anaesth. 2018; 12(3): 440. [DOI:10.4103/sja.SJA_47_18] [PMID] []
24. Majidinejad S, Esmailian M, Emadi M. Comparison of intravenous ketamine with morphine in pain relief of long bones fractures: a double blind randomized clinical trial. Emerg (Tehran). 2014 Spring; 2(2): 77-80.
25. Motov S, Mann S, Drapkin J, Butt M, Likourezos A, Yetter E, et al. Intravenous subdissociative-dose ketamine versus morphine for acute geriatric pain in the Emergency Department: A randomized controlled trial. Am J Emerg Med. 2019; 37(2): 220-7. [DOI:10.1016/j.ajem.2018.05.030] [PMID]
26. Jennings PA, Cameron P, Bernard S. Ketamine as an analgesic in the pre-hospital setting: a systematic review. Acta Anaesthesiol Scand. 2011; 55(6): 638-43. [DOI:10.1111/j.1399-6576.2011.02446.x] [PMID]
27. Goyal S, Agrawal A. Ketamine in status asthmaticus: A review. Indian J Crit Care Med. 2013; 17(3): 154-61. [DOI:10.4103/0972-5229.117048] [PMID] []
28. Mahshidfar B, Mofidi M, Fattahi M, Farsi D, Hafezi Moghadam P, Abbasi S, Rezai M. Acute pain management in emergency department, low dose ketamine versus morphine, A randomized clinical trial. Anesth Pain Med. 2017; 7(6): e60561. [DOI:10.5812/aapm.60561] [PMID] []
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