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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Saturday, November 7, 2015

Ketamina vs Morfina

"Our Conclusions
In this well designed non-inferiority study, a single subdissociative dose of ketamine was found to have similar effectiveness as morphine for short-term (<30 minute) control of pain in ED patients. Furthermore, this article suggests that ketamine may provide more rapid relief of pain as compared to morphine. Although the authors conclude that ketamine also has the same safety profile, given the small sample size, this study may have been inadequately powered to detect a significant number of adverse events. In addition, although minor adverse effects were not found to be clinically significant, they should not be considered negligible. Patients should be made aware of the potential side effects prior to use, as these may deter use of the medication in the future. Clinicians must be judicious in patient selection as this study excluded many patients (i.e. older age, pregnancy, hepatic insufficiency, psychiatric disease). Further studies are warranted to compare the efficacy of re-dosing ketamine, given most patients presenting to the ED endorsing moderate to severe pain have an average length of stay longer than 30 minutes.
Potential Impact To Current Practice
This study adds to the mounting evidence that ketamine may be a good alternative or, at least, second line agent to opiates for the treatment of pain in ED patients. Although many emergency providers have incorporated ketamine into their pain management algorithm, those less experienced with the drug may be reluctant to change their practice unless evidence shows a clear benefit over opiates.
Bottom Line
In the appropriate patient, subdissociative doses of ketamine may be considered as an alternative to opiates for first-line treatment of moderate to severe pain in ED patients."