Efficacy and Safety of Ketamine Versus Morphine in Out-of-hospital Analgesia in Patients with Traumatic Pain: An Updated Systematic Review and Meta-analysis of Randomized Controlled Trials
Mohammed Baker1, FADI QASIM NASER ALTAMIMI2, Layan Feras Khleifat3, Toleen Haddad4, Maha Jaradat5, Mais Haitham Khalil6
1Jordan University of Science and Technology, 2Faculty of Medicine, Faculty of Medicine, Yerevan state medical Unversity, Armenia, 3Faculty of Medicine, Al-Balqa Applied University, Salt, Jordan, 4Faculty of Medicine, University of Jordan, Amman, Jordan, 5Faculty of Medicine, University of Jordan, Irbid, Jordan, 6Faculty of Science, Philadelphia University, Jerash, Jordan
Objective:
To update the data about the safety and efficacy of ketamine compared to morphine in the pre-hospital management of traumatic pain.
Background:
Higher rates of adverse effects of morphine raises the need for safer and more effective alternatives. Many articles suggest ketamine as an alternative option to morphine.
Design/Methods:
We systematically searched PubMed/Medline, Scopus, Web of Science, and the Cochrane Library for RCTs comparing Ketamine versus Morphine for prehospital analgesia of traumatic pain. The primary outcome was the analgesic effect in terms of the mean difference of pain scores. Secondary outcomes included the vital signs changes and complications rates.
Results:
Out of 2027 reports, four studies were included in the final analysis, including 757 patients. The intervention group had a mean age of 41.9 (6) years, compared to 43.4 (7.3) years in the control group, with men accounting for 66% (n = 500). Pooled analysis revealed that ketamine wasn't more effective than morphine in terms of analgesic effect (mean difference [MD] = -0.90, [95% CI, -2.19 to 0.40, p=0.17]).Also, there was no significant difference between both arms in terms of change in the heart rate (MD = 0.40, 95% CI = [-2.08 to 2.88], p = 0.75), or respiratory rate (MD = 0.36, 95% CI = [-0.63 to 1.36], p = 0.72). On the other hand, there was a significant difference between the two arms in terms of change in systolic blood pressure favoring the control group (mean difference = 6.27, 95% CI = [2.97 to 9.57], p = 0.0002).Ketamine has higher incidence of adverse events compared to morphine (64.5% vs 35.5%).
Conclusions:
This meta-analysis shows that Ketamine is not superior to Morphine in terms of prehospital analgesia of traumatic pain and is associated with higher rate of adverse effects. We don’t recommend using ketamine as an alternative to morphine for prehospital analgesia.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.