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Patient Issues Author: Staff Editor Last Updated: Sep 7, 2017 - 10:06:33 PM

Morphine Plus Ketamine Works Better Than Morphine Alone

By Staff Editor
Jan 13, 2012 - 10:34:32 AM

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( - WASHINGTON-Trauma patients who were given ketamine in addition to morphine prior to arriving at the emergency department had nearly 50 percent better pain management than patients who were given only morphine, according to a study published online yesterday in Annals of Emergency Medicine ("Morphine and Ketamine Is Superior to Morphine Alone for Prehospital Trauma Analgesia: A Randomized Controlled Trial")

"Ketamine plus morphine delivered superior pain relief to trauma patients with moderate to severe pain in the out-of-hospital setting," said lead study author Dr. Paul Jennings of Monash University in Melbourne, Australia. "The addition of ketamine did cause more side effects, but they were minor and there were no serious adverse events reported."

Researchers enrolled 135 patients in the study and randomly assigned them to two groups, one receiving only morphine, one receiving morphine and ketamine. All patients initially received five milligrams of morphine intravenously. Sixty-five patients subsequently received five milligrams of morphine intravenously every 5 minutes until they were pain-free. Seventy patients subsequently received 10 or 20 milligrams of ketamine, followed by 10 milligrams every three minutes.

The average pain score for the ketamine group dropped 5.6 points (out of 10), while the morphine group pain scores dropped only 3.2 points. Of the morphine-only group, 14 percent had side effects, most commonly nausea. Of the morphine plus ketamine group, 39 percent had side effects, most commonly disorientation.

"Supplementing out-of-hospital morphine with low-dose ketamine is an effective strategy to mitigate trauma pain," said Dr. Jennings.

Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, a national medical society. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information visit

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