Comparing low-dose intravenous ketamine-midazolam with intravenous morphine with respect to pain control in patients with closed limb fracture

Background: We assessed the eff ects of low-dose IV ketamine-midazolam versus morphine on pain control in patients with closed limb fracture(s); and also compared the incidence of adverse events (cardio-pulmonary) between two groups. Materials and Methods: Th is prospective, single-blind, non-inferiority trial randomized consecutive emergency department (ED) patients aged 18-60 years to two groups: Receiving 300-500 mcg/kg ketamine plus 0.03 mg/kg midazolam, or 0.05-0.1 mg/kg morphine. Visual analogue score (VAS) and adverse events were verifi ed during an interval of 30 minutes. Results: Two hundred and thirty — six patients were selected, among whom 207 were males (87.3%). Th e average age was 29 ± 2, (range, 18-60 years). Th e VAS score at T30 (i.e., 30 minutes after initial analgesic dose) was signifi cantly decreased compared with VAS score at T0, in both groups. No statistically signifi cant diff erence, however, was observed between the two groups (–6.1 ± 1.1 versus –6.2 ± 1.0; P = 0.16). With regard to systolic blood pressure and respiratory rate, however, a meaningful diff erence was noted between the two groups (1.5 ± 6.4 versus –2.1 ± 6.6; P = 0.000 for SBP, and –0.2 ± 1.1 versus –1.1 ± 6.1; P = 0.048 for RR). Conclusion: “Low-dose” intravenous ketamine plus midazolam has the same analgesic eff ects as morphine on pain control in trauma patients with closed limb fracture(s), in addition to less respiratory adverse events.