Miller Joshua P, Schauer Steven G, Ganem Victoria J, Bebarta Vikhyat S
Department of Emergency Medicine, San Antonio Military Medical Center, Houston, TX; Department of Emergency Medicine, Bergan Mercy Medical Center, Omaha, NE.
Department of Emergency Medicine, San Antonio Military Medical Center, Houston, TX; Department of Emergency Medicine, Bayne-Jones Army Community Hospital, Fort Polk, LA.
Am J Emerg Med. 2015 Mar;33(3):402-8. doi: 10.1016/j.ajem.2014.12.058. Epub 2015 Jan 7.
To compare the maximum change in numeric rating scale (NRS) pain scores, in patients receiving low-dose ketamine (LDK) or morphine (MOR) for acute pain in the emergency department.
We performed an institutional review board-approved, randomized, prospective, double-blinded trial at a tertiary, level 1 trauma center. A convenience sample of patients aged 18 to 59 years with acute abdominal, flank, low back, or extremity pain were enrolled. Subjects were consented and randomized to intravenous LDK (0.3mg/kg) or intravenous MOR (0.1mg/kg). Our primary outcome was the maximum change in NRS scores. A sample size of 20 subjects per group was calculated based on an 80% power to detect a 2-point change in NRS scores between treatment groups with estimated SDs of 2 and an α of .05, using a repeated-measures linear model.
Forty-five subjects were enrolled (MOR 21, LDK 24). Demographic variables and baseline NRS scores (7.1 vs 7.1) were similar. Ketamine was not superior to MOR in the maximum change of NRS pain scores, MOR=5 (confidence interval, 6.6-3.5) and LDK=4.9 (confidence interval, 5.8-4). The time to achieve maximum reduction in NRS pain scores was at 5 minutes for LDK and 100 minutes for MOR. Vital signs, adverse events, provider, and nurse satisfaction scores were similar between groups.
Low-dose ketamine did not produce a greater reduction in NRS pain scores compared with MOR for acute pain in the emergency department. However, LDK induced a significant analgesic effect within 5 minutes and provided a moderate reduction in pain for 2 hours.
比较在急诊科接受低剂量氯胺酮（LDK）或吗啡（MOR）治疗急性疼痛的患者中，数字评分量表（NRS）疼痛评分的最大变化。
我们在一家三级一级创伤中心进行了一项经机构审查委员会批准的随机、前瞻性、双盲试验。纳入了年龄在18至59岁之间、患有急性腹部、胁腹、下背部或肢体疼痛的便利样本患者。受试者签署知情同意书后，被随机分为静脉注射LDK（0.3mg/kg）或静脉注射MOR（0.1mg/kg）。我们的主要结局是NRS评分的最大变化。使用重复测量线性模型，根据检测治疗组间NRS评分2分变化的80%检验效能、估计标准差为2以及α为0.05，计算出每组20名受试者的样本量。
共纳入45名受试者（MOR组21名，LDK组24名）。人口统计学变量和基线NRS评分（7.1对7.1）相似。氯胺酮在NRS疼痛评分的最大变化方面并不优于吗啡，MOR组变化值为5（置信区间，6.6 - 3.5），LDK组为4.9（置信区间，5.8 - 4）。LDK组达到NRS疼痛评分最大降幅的时间为5分钟，MOR组为100分钟。两组间生命体征、不良事件、医生和护士满意度评分相似。
在急诊科治疗急性疼痛时，低剂量氯胺酮与吗啡相比，并未使NRS疼痛评分有更大程度的降低。然而，LDK在5分钟内诱导出显著的镇痛效果，并在2小时内使疼痛适度减轻。
