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Is Subdissociative Ketamine As Safe and Effective As Morphine for Pain Management in the Emergency Department?

Howard, Patricia Kunz PhD, RN, CEN, CPEN, TCRN, NE-BC, FAEN, FAAN; Gisness, Christine M. RN, MSN, FNP-C, CEN, TCRN, FAEN

Section Editor(s): Howard, Patricia Kunz PhD, RN, CEN, CPEN, TCRN, NE-BC, FAEN, FAAN; Column Editors; Shapiro, Susan E. PhD, RN, FAAN; Column Editors

Advanced Emergency Nursing Journal: April/June 2017 - Volume 39 - Issue 2 - p 81–85
doi: 10.1097/TME.0000000000000145

Review of recent evidence with translation to practice for the advanced practice nurse (APN) role is presented using a case study module for “Intravenous Subdissociative-Dose Ketamine Versus Morphine for Analgesia in the Emergency Department: A Randomized Controlled Trial.” This prospective, randomized controlled inquiry enrolled 90 patients into 2 groups (ketamine vs. morphine) for patients seeking care in an emergency department with acute pain. Data regarding pain scores were collected at baseline, 15, 30, 60, 90, and 120 min. Study subjects reporting persistent pain could receive rescue analgesia with fentanyl. Initial pain scores for the subjects in each of the groups were comparable (ketamine: 8.6; morphine: 8.5). Pain management for the 2 groups revealed similar average doses (ketamine: 21.8 mg; morphine: 7.7 mg). Although subjects in both groups reported reduction in pain scores at 15 and 30 min, no clinical significance was found. Subjects experienced greater pain relief (pain score = 0) in the ketamine group at 15 min (percentage difference 31%; 95% confidence interval [13, 49]), yet this was not sustained at the 30-min interval. There were no serious or life-threatening adverse effects in either group. This study highlights the important role of the APN in providing quality care, communication about pain management, and related follow-up care.

Emergency Services, University of Kentucky HealthCare, Lexington (Dr Kunz Howard); and Department of Emergency Medicine at Grady Hospital, Emory University, Atlanta, Georgia (Ms Gisness).

Corresponding Author: Patricia Kunz Howard, PhD, RN, CEN, CPEN, TCRN, NE-BC, FAEN, FAAN, Emergency Services, University of Kentucky HealthCare, 1000 S. Limestone St, Lexington, KY 40536 (

Disclosure: The authors report no conflicts of interest.

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