RCTs comparing ketamine to morphine in treatment of acute SCD pain
| Authors . | Population . | Intervention . | Primary outcome . | Results . | Conclusions . |
|---|---|---|---|---|---|
| Lubega et al., 201811 | 240 children between 7 and 18 years with severe sickle cell pain crisis | IV ketamine 1 mg/kg compared to IV morphine 0.1 mg/kg infusion over 10 min | Maximal change in NRS pain score | - IV ketamine was comparable to IV morphine in maximum change in NRS scores. - IV ketamine was associated with high prevalence (11-fold increase) of transient, mild side effects such as nystagmus, dysphoria, dizziness, nausea, vomiting, increased salivation, and pruritis compared to morphine. | - IV ketamine can be a reliable alternative to morphine in management of severe acute sickle cell pain - Further studies are needed to determine optimal ketamine dosing and infusion rate to reduce transient side effects. |
| Alshahrani et al., 202212 | 278 adults with acute sickle cell pain crisis | IV ketamine 0.3 mg/kg compared to morphine 0.1 mg/kg infused over 30 min in the ED | Mean difference in pain NRS over 2 h | - Mean pain NRS scores between ketamine and morphine groups were similar. - Those who received ketamine had reduced cumulative morphine dose (0.07 mg/kg) compared to those receiving morphine (0.13 mg/kg); P < .001. - Cumulative morphine dose analysis between groups did not control for the initial morphine intervention dose (vs initial ketamine intervention dose). This confounds study results as the morphine group would have increased morphine consumption compared to the ketamine group at time of intervention by study design. | - Early ketamine use in acute sickle cell pain had an analgesic effect with less accumulative morphine doses needed. |
| Authors . | Population . | Intervention . | Primary outcome . | Results . | Conclusions . |
|---|---|---|---|---|---|
| Lubega et al., 201811 | 240 children between 7 and 18 years with severe sickle cell pain crisis | IV ketamine 1 mg/kg compared to IV morphine 0.1 mg/kg infusion over 10 min | Maximal change in NRS pain score | - IV ketamine was comparable to IV morphine in maximum change in NRS scores. - IV ketamine was associated with high prevalence (11-fold increase) of transient, mild side effects such as nystagmus, dysphoria, dizziness, nausea, vomiting, increased salivation, and pruritis compared to morphine. | - IV ketamine can be a reliable alternative to morphine in management of severe acute sickle cell pain - Further studies are needed to determine optimal ketamine dosing and infusion rate to reduce transient side effects. |
| Alshahrani et al., 202212 | 278 adults with acute sickle cell pain crisis | IV ketamine 0.3 mg/kg compared to morphine 0.1 mg/kg infused over 30 min in the ED | Mean difference in pain NRS over 2 h | - Mean pain NRS scores between ketamine and morphine groups were similar. - Those who received ketamine had reduced cumulative morphine dose (0.07 mg/kg) compared to those receiving morphine (0.13 mg/kg); P < .001. - Cumulative morphine dose analysis between groups did not control for the initial morphine intervention dose (vs initial ketamine intervention dose). This confounds study results as the morphine group would have increased morphine consumption compared to the ketamine group at time of intervention by study design. | - Early ketamine use in acute sickle cell pain had an analgesic effect with less accumulative morphine doses needed. |
NRS, numerical rating scale.