Carver TW, Kugler NW, Juul J, et al. J Trauma Acute Care Surg 86: 181-188, 2019. DOI: 10.1097/TA.0000000000002103
| Background | Rib fractures occur in up to 40% of human patients and are associated with increased mortality. |
| Rational and Objective | Aggressive pain management needed to reduce pulmonary complications. Opioids most commonly used but non-opioid alternatives are preferable. Ketamine being used in authors’ hospital but evidence anecdotal. |
| Trial Design | Prospective, randomized, double-blinded, placebo controlled. |
| Patient population and location | Adults with 3 or more fractured ribs between 2015-2017. Level 1 Trauma Center |
| Methods | Experimental group: ketamine 2.5 mcg/kg/min. Placebo group: equivalent rate 0.9% saline. All infusions for 48h. Exclusion: 15 exclusion criteria (age, cardiovascular, neurological, pharmacological, psychological, etc.)82 patients to achieve 80% power. |
| Endpoints (if applicable) | Primary endpoint: reduction in numeric pain score (NPS) of 2 points in 11-point scale during first 24h. Secondary endpoint: oral morphine equivalent (OME) used, length of stay, use of epidural, pulmonary complications, adverse events. |
| Results | 91 patients similar groups – 75% male, median age 49 yr, Injury Severity Score (ISS) 14. No reduction in 24 hr NPS or OME. In ISS >15 low dose ketamine associated with significant reduction in OME. No differences in uses of other analgesia. No differences in other secondary outcomes or adverse events up to 30 days post discharge. |
| Limitations | Use of NPS. No ability to titrate ketamine so under-dosing possible. |
| Clinical Relevance Conclusions | Low dose ketamine may be useful in more severely injured patients. Optimal dose for ketamine still unknown; higher dose may be more effective. |