Deaths from heroin rose to 8,260 in 2013, quadrupling since 2000 and aggravating what some were already calling the worst drug overdose epidemic in United States history. Overall, drug overdoses now cause more deaths than car crashes, with opioids like OxyContin and other pain medications killing 44 people a day. We’re aware that the opioid epidemic in our country is currently a public health crisis; I’m looking at alternatives to opioids for pain control in the ED.
Ketamine is often used as an alternative to narcotics to manage acute pain in the Emergency Department. It acts primarily as an antagonist of the NMDA receptor and at different doses can cause analgesic, dissociative and recreational effects. A 2015 Annals article looked compared a subdissociative dose of ketamine to morphine for pain control. The study occurred at a single site teaching hospital and compared 0.3mg/kg ketamine to 0.1mg/kg morphine for a primary outcome of comparative reduction of numeric rating scale pain scores at 30 minutes and a secondary outcome of the incidence of rescue analgesia at 30 and 60 minutes.
The study found change in mean pain scores was not significantly different in the ketamine and morphine groups: 8.6 versus 8.5 at baseline (mean difference 0.1; 95% CI: 0.46, 0.77) and 4.1 versus 3.9 at 30 minutes (mean difference 0.2; 95% CI: 1.19, 1.46; P=0.97) and concluded that subdissociative intravenous ketamine administered at 0.3 mg/kg provides analgesic effectiveness and apparent safety comparable to that of intravenous morphine for short-term treatment of acute pain in the ED.
Motov et al. Intravenous Subdissociative-Dose Ketamine Versus Morphine for Analgesia in the Emergency Department: A Randomized Controlled Trial. Ann Emerg Med 2015