Evaluation of Low-Dose Ketamine and Dexmedetomidine Compared to Morphine for Control of Traumatic Limb Pain in the Emergency Department: A Randomized Clinical Trial Publisher Pubmed



Moradi MM ; Barootchi E ; Najmeddin F ; Sotoodehnia M ; Barikro N ; Khanlarzadeh M ; Jalali A
Source: Journal of Emergency Medicine Published:2025

Abstract

Background: Opioids have been traditionally used for acute pain management; however, they are associated with side effects, including respiratory depression, physical dependence, and potential misuse. Ketamine is known to be an effective agent in reducing pain with side effects that have been shown to diminish with concurrent dexmedetomidine administration. Objectives: The purpose of this study is to compare the use of ketamine-dexmedetomidine (K-D) with morphine for acute traumatic limb pain. Methods: In this single-center, randomized controlled trial, 258 adult patients who presented to the emergency department with acute limb trauma pain were examined. One group received intravenous (IV) ketamine (0.3 mg/kg) plus dexmedetomidine (0.5 mcg/kg), and the other group IV morphine (0.1 mg/kg). Pain, agitation scores, and side effects were compared between the two groups. Pain reduction at 30 min (primary outcome) was analyzed using independent t-test. Results: The mean pain score of patients in the K-D group was lower than the morphine group 30 min postinjection (K-D: 1.4 ± 2.3, morphine: 3.3 ± 2.3, p < 0.001). The need for rescue analgesic was 8.3% in the K-D group and 24% in the morphine (M) group. The mean agitation score in the ketamine group was higher during the first 10 min postinjection (K-D: 0.1 ± 0.6, p = 0.052, M: 0.0 ± 0.2, p = 0.002) but this was resolved by 30 min (K-D: 0.0 ± 0.3, p = 0.007, M: 0.0 ± 0.2, p = 0.006). Conclusion: K-D controlled traumatic limb pain more effectively than morphine and was generally well tolerated. Our results suggest K-D may be a good alternative to opioids in controlling acute pain. © 2025 Elsevier B.V., All rights reserved.