Efficacy of Intravenous Sub-Dissociative Ketamine Versus Intravenous Morphine in Children With Acute Pain
Columbia University
Summary
Pain is common in children presenting to the emergency department but is frequently undertreated, leading to both short- and long-term consequences. Morphine is the standard treatment for children with moderate to severe acute pain, but its use is associated with serious side effects and caregiver and clinician concerns related to opioid administration. The investigators aim to determine if sub-dissociative ketamine is non-inferior to morphine for treating acute pain and a preferable alternative for treating acute pain in children because of its more favorable side effect profile and potential long-term benefits related to pain-related function, analgesic use/misuse, and mental and behavioral health outcomes.
Description
Aim 1: To determine if IV sub-dissociative ketamine is non-inferior to IV morphine for decreasing pain intensity in children presenting to an ED with acute pain. The investigators hypothesize that IV sub-dissociative ketamine is non-inferior to IV morphine for decreasing pain intensity in children with acute abdominal pain or an extremity fracture. Aim 2: To compare the rate of acute (\<2 hours) adverse events, including cardiopulmonary adverse events, associated with IV sub-dissociative ketamine and IV morphine. The investigators hypothesize that there is a smaller proportion of cardiopulmon…
Eligibility
- Age range
- 6–17 years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: 1. Abdominal pain or isolated long-bone extremity fracture (suspected or proven) 2. Self-reported pain score of ≥ 6/10 3. Requires IV morphine for analgesia as determined by the treating physician Exclusion Criteria: 1. Weight \> 82.4 kg 2. Known allergy/contraindication to morphine or ketamine 3. Antecedent receipt of ketamine related to presenting complaint 4. Inability to use self-report measures of pain or questionnaires 5. Chronic disease associated with pain 6. Chronic pain condition requiring use of opioids as outpatient 7. Hemodynamic instability or critical illn…
Interventions
- DrugKetamine hydrochloride
Sub-dissociative ketamine, IV
- DrugMorphine sulphate
Morphine, IV
Locations (8)
- Children's Hospital Los AngelesLos Angeles, California
- UC Davis Children's HospitalSacramento, California
- Nemours Children's HospitalWilmington, Delaware
- Arthur M. Blank HospitalAtlanta, Georgia
- NewYork Presbyterian Morgan Stanley Children's HospitalNew York, New York
- UPMC Children's Hospital of PittsburghPittsburgh, Pennsylvania