Ketamine versus hydromorphone patient-controlled analgesia for acute pain in trauma patients

被引:11
|
作者
Takieddine, Sheila C. [1 ]
Droege, Christopher A. [2 ]
Ernst, Neil [2 ]
Droege, Molly E. [2 ]
Webb, Megan [2 ,4 ]
Branson, Richard D. [3 ]
Gerlach, Travis W. [3 ,5 ]
Robinson, Bryce R. H. [3 ,6 ]
Johannigman, Jay A. [3 ]
Mueller, Eric W. [2 ]
机构
[1] UC Hlth, Dept Pharm, Cincinnati, OH USA
[2] Univ Cincinnati, Med Ctr, UC Hlth, Dept Pharm, Cincinnati, OH 45267 USA
[3] Univ Cincinnati, Dept Surg, 231 Bethesda Ave, Cincinnati, OH 45267 USA
[4] Baptist Hlth Louisville, Dept Pharm, Louisville, KY USA
[5] UC Davis Med Ctr, Dept Surg, Sacramento, CA USA
[6] Univ Washington, Dept Surg, Seattle, WA 98195 USA
关键词
Ketamine; Analgesia; Trauma; Hydromorphone; Randomized control trial; MAJOR ABDOMINAL-SURGERY; POSTOPERATIVE ANALGESIA; ADDING KETAMINE; UNITED-STATES; MORPHINE; CARE; OPIOIDS; TRIAL;
D O I
10.1016/j.jss.2017.12.019
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: It is unknown whether ketamine administered via patient-controlled analgesia (PCA) provides adequate analgesia while reducing opioid consumption in the traumatically injured patient. Differences in opioid consumption, pain scores, and adverse effects between ketamine and hydromorphone PCA were studied. Materials and methods: This is an investigator-initiated, single-center, double-blinded, randomized, pilot trial conducted from 2014 to 2016 at a level 1 trauma center. Nonintubated trauma patients in intensive care, who were receiving PCA, were randomized to ketamine or hydromorphone PCA plus opioid analgesics for breakthrough pain. Results: Twenty subjects were randomized. There was no difference in median daily breakthrough opioid use (10 [0.63-19.38] mg versus 10 [4.38-22.5] mg, P = 0.55). Subjects in the ketamine group had lower median cumulative opioid use on therapy day 1 than the hydromorphone group (4.6 [2.5-15] mg versus 41.8 [31.8-50] mg, P < 0.001), as well as in the first 48 h (10 [3.3-15] mg versus 48.5 [32.1-67.5] mg, P < 0.001) and first 72 h (10 [4.2-15] mg versus 42.5 [31.7-65.2] mg, P < 0.001) of therapy. Daily oxygen supplementation requirements were lower in the ketamine group (0.5 [0-1.5] L/min versus 2 [0.5-3] L/min, P = 0.020). Hallucinations occurred more frequently in the ketamine group (40% versus 0%, P = 0.090). Conclusions: Ketamine PCA led to lower cumulative opioid consumption and lower oxygen supplementation requirements, though hallucinations occurred more frequently with use of ketamine. Additional studies are needed to investigate the tolerability of ketamine as an alternative to traditional opioid-based PCA. (C) 2017 Elsevier Inc. All rights reserved.
引用
收藏
页码:6 / 14
页数:9
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