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Future studies are required to confirm the efficacy of
low dose ketamine as a useful alternative to opioids in rib fracture patients.
According to the latest study published in the “Journal of Trauma and Acute Care Surgery”, low dose ketamine was unable to reduce the pain or usage of oral morphine in patients with rib fractures.
A total of 40% of trauma patients were presented with rib fractures and prolonged mortality. Opiate-based pain approaches are considered as the base of rib fracture management; but, problems or side effects associated with opioids have raised the interest of investigators in exploring alternative approaches. The recently used medication instead of opioids is low dose ketamine (LDK), but the evidence regarding its efficacy is limited.
The adults with ≥three rib fractures, >64 years old, use chronic opiate and with <13 Glasgow Coma Scale score admitted to a Level 1 trauma center were selected for analysis. The patients of the experimental group obtained 2.5 mcg/kg/min LDK and placebo achieved an equivalent rate of 0.9% normal saline. All infusions proceeded for two days. Reduction in numeric pain score (NPS) at the first 24 hours was considered as the primary endpoint and length of stay, pulmonary complications, oral morphine equivalent (OME) utilization, adverse events, and epidural rates were regarded as the secondary endpoints.
Forty-five out of 91 individuals with mean 49 years old
with an ISS of 14 completed the analysis. The pattern was same for both groups.
LDK was not correlated with a significant decrease in 24-hour OME or NPS totals.
However, during the subgroup analysis of 45 critically injured individuals
showed an association between LDK and a significant reduction in OME use at the
first 24-hours, 24-48 hours, and overall. The groups exhibited no difference in
other secondary endpoints or adverse events.
Journal of Trauma and Acute Care Surgery
Ketamine Infusion for Pain Control in Adult Patients with Multiple Rib Fractures: Results of a Randomized Control Trial
Thomas W. Carver et al.
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