Mahmoodabadi Hossein Zabihi, Javadein Zeynab Seyed, Moosaie Fatemeh, Faegh Ali, Bahreini Maryam
Fellowship in Advanced Minimally Invasive and Bariatric Surgery, Tehran University of Medical Sciences, Tehran, Iran.
Department of General Surgery, Sina Hospital, Tehran Medical University of Sciences, Tehran, Iran.
Acad Emerg Med. 2025 Apr;32(4):426-433. doi: 10.1111/acem.15050. Epub 2024 Dec 31.
Pain management is a critical part of treatment in patients with chest trauma. Opioids and nonsteroidal anti-inflammatory drugs have been the most commonly used medications. However, their side effects have drawn attention to other medications. In this study, we aimed to assess the effect of the analgesic dose of ketamine in patients with chest trauma in comparison to ketorolac.
A randomized, double-blind clinical trial was conducted in three hospitals. Patients were randomly allocated into two groups: 45 in the ketorolac group (30 mg intravenous [IV] and 45 in the ketamine group [0.25 mg/kg IV]). Pain was rated via numeric rating scale (NRS) before and 30 and 60 min after the drug injection. Morphine was used as the rescue medication. Furthermore, the adverse events of the two study regimens were rated.
Pain was more significantly relieved in the ketamine group, 30 and 60 min after drug administration, compared to ketorolac (median [IQR] 95% CI 30-min NRS 3.0 [1.0] 2.8-3.5 vs. 5.0 [4.5] 4.2-5.8, p = 0.006; and 60-min NRS 3.0 [2.0] 2.7-3.7 vs. 5.6 [1.7] 4.7-6.4, p < 0.001), respectively. Among patients with a chest tube, pain was more significantly controlled in the ketamine group (p < 0.001). Also, patients in the ketamine group needed less rescue pain medications compared to the ketorolac group although they reported more frequent nausea.
Ketamine can be an effective analgesic in patients with chest trauma in acute settings with or without rib fracture.
疼痛管理是胸部创伤患者治疗的关键部分。阿片类药物和非甾体类抗炎药一直是最常用的药物。然而，它们的副作用使人们开始关注其他药物。在本研究中，我们旨在评估与酮咯酸相比，镇痛剂量的氯胺酮对胸部创伤患者的影响。
在三家医院进行了一项随机、双盲临床试验。患者被随机分为两组：酮咯酸组45例（静脉注射30mg），氯胺酮组45例（静脉注射0.25mg/kg）。在药物注射前、注射后30分钟和60分钟通过数字评分量表（NRS）对疼痛进行评分。吗啡用作急救药物。此外，对两种研究方案的不良事件进行评分。
与酮咯酸相比，氯胺酮组在给药后30分钟和60分钟时疼痛缓解更为显著（中位数[四分位间距]95%置信区间30分钟NRS 3.0[1.0]2.8 - 3.5 vs. 5.0[4.5]4.2 - 5.8，p = 0.006；60分钟NRS 3.0[2.0]2.7 - 3.7 vs. 5.6[1.7]4.7 - 6.4，p < 0.001）。在有胸管的患者中，氯胺酮组的疼痛控制更为显著（p < 0.001）。此外，氯胺酮组患者所需的急救止痛药物比酮咯酸组少，尽管他们报告恶心更频繁。
氯胺酮可作为急性情况下有或无肋骨骨折的胸部创伤患者的有效镇痛药。
