Management of severe acute pain in emergency settings: ketamine reduces morphine consumption

Am J Emerg Med. 2007 May;25(4):385-90. doi: 10.1016/j.ajem.2006.11.016.


Objective: The aim of the study was to compare in emergency settings 2 analgesic regimens, morphine with ketamine (K group) or morphine with placebo (P group), for severe acute pain in trauma patients.

Methods: This was a prospective, multicenter, randomized, double-blind, clinical trial. Seventy-three trauma patients with a severe acute pain defined as a visual analog scale (VAS) score of at least 60/100 were enrolled. Patients in the K group received 0.2 mg x kg(-1) of intravenous ketamine over 10 minutes, and patients in the P group received isotonic sodium chloride solution. In both groups, patients were given an initial intravenous morphine injection of 0.1 mg x kg(-1), followed by 3 mg every 5 minutes. Efficient analgesia was defined as a VAS score not exceeding 30/100. The primary end points were morphine consumption and VAS at 30 minutes (T30).

Results: At T30, morphine consumption was significantly lower in the K group vs the P group, with 0.149 mg x kg(-1) (0.132-0.165) and 0.202 mg x kg(-1) (0.181-0.223), respectively (P < .001). The VAS score at T30 did not differ significantly between the 2 groups, with 34.1 (25.6-42.6) in the K group and 39.5 (32.4-46.6) in the P group (P = not significant).

Conclusion: Ketamine was able to provide a morphine-sparing effect.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adult
  • Analgesics / administration & dosage*
  • Dose-Response Relationship, Drug
  • Double-Blind Method
  • Drug Therapy, Combination
  • Emergency Medicine / methods
  • Female
  • Humans
  • Infusions, Intravenous
  • Injections, Intravenous
  • Ketamine / administration & dosage*
  • Male
  • Morphine / administration & dosage*
  • Pain / diagnosis
  • Pain / drug therapy*
  • Pain / etiology
  • Pain Measurement
  • Patient Satisfaction
  • Preanesthetic Medication*
  • Prospective Studies
  • Treatment Outcome
  • Wounds and Injuries / complications*


  • Analgesics
  • Ketamine
  • Morphine