Galinski Michel, Dolveck François, Combes Xavier, Limoges Véronique, Smaïl Nadia, Pommier Véronique, Templier François, Catineau Jean, Lapostolle Frédéric, Adnet Frédéric
Samu 93-EA 3409 Avicenne Hospital, 93009 Bobigny Cedex, France.
Am J Emerg Med. 2007 May;25(4):385-90. doi: 10.1016/j.ajem.2006.11.016.
The aim of the study was to compare in emergency settings 2 analgesic regimens, morphine with ketamine (K group) or morphine with placebo (P group), for severe acute pain in trauma patients.
This was a prospective, multicenter, randomized, double-blind, clinical trial. Seventy-three trauma patients with a severe acute pain defined as a visual analog scale (VAS) score of at least 60/100 were enrolled. Patients in the K group received 0.2 mg x kg(-1) of intravenous ketamine over 10 minutes, and patients in the P group received isotonic sodium chloride solution. In both groups, patients were given an initial intravenous morphine injection of 0.1 mg x kg(-1), followed by 3 mg every 5 minutes. Efficient analgesia was defined as a VAS score not exceeding 30/100. The primary end points were morphine consumption and VAS at 30 minutes (T30).
At T30, morphine consumption was significantly lower in the K group vs the P group, with 0.149 mg x kg(-1) (0.132-0.165) and 0.202 mg x kg(-1) (0.181-0.223), respectively (P < .001). The VAS score at T30 did not differ significantly between the 2 groups, with 34.1 (25.6-42.6) in the K group and 39.5 (32.4-46.6) in the P group (P = not significant).
Ketamine was able to provide a morphine-sparing effect.
本研究旨在比较在急诊环境中，两种镇痛方案，即吗啡联合氯胺酮（K组）或吗啡联合安慰剂（P组），用于创伤患者的严重急性疼痛。
这是一项前瞻性、多中心、随机、双盲临床试验。纳入73例严重急性疼痛的创伤患者，其视觉模拟评分（VAS）至少为60/100。K组患者在10分钟内静脉注射0.2mg/kg氯胺酮，P组患者接受等渗氯化钠溶液。两组患者均先静脉注射0.1mg/kg吗啡，随后每5分钟注射3mg。有效镇痛定义为VAS评分不超过30/100。主要终点为30分钟时（T30）的吗啡消耗量和VAS评分。
在T30时，K组的吗啡消耗量显著低于P组，分别为0.149mg/kg（0.132 - 0.165）和0.202mg/kg（0.181 - 0.223）（P <.001）。两组在T30时的VAS评分无显著差异，K组为34.1（25.6 - 42.6），P组为39.5（32.4 - 46.6）（P =无显著性差异）。
氯胺酮能够产生节省吗啡的效果。
