Comparison of Intravenous and Intranasal Ketamine and Intravenous Morphine in Pain Relief of Bone Fractures

Abstract

Pain reduction is one of the most critical issues in the treatment of patients and is considered as one of the fundamental rights of humans. Considering the high intensity of pain in bone fracture patients and the importance of emergency pain control in these patients, in this study, we decided to investigate the effectiveness of intravenous and intranasal ketamine in reducing the pain of patients who suffered various types of bone fractures and went to the emergency room. Also, their effectiveness was compared with intravenous morphine. Materials and Method: In this double-blind clinical trial, patients over 18 years of age who were referred to the emergency department with long bone fractures were divided into three treatment groups: intravenous ketamine at a dose of 0.5 mg/kg of body weight and intranasal ketamine at a dose of 1 mg/kg of body weight and intravenous morphine with a dose of 0.1 mg/kg body weight. The patients' pain intensity was recorded and analyzed based on the numerical pain rating scale upon arrival, 15 minutes, 30 minutes, and 60 minutes after receiving the medicine. Results: 140 patients were included in the study. There were 46 people in the intravenous ketamine group and 47 people in each of the intranasal ketamine and intravenous morphine groups. The average age of the patients was 49.1 ± 19.8 years. The most reported trauma mechanism was a car accident in 79 cases (56%). No significant difference was observed when comparing the pain management efficiency between the three study groups (P=0.773). The interaction of time and type of drug had no significant effect on pain level (P=0.583). No significant difference was found in side effects reported by patients in the three groups. Side effects reported in the intranasal ketamine group were not significant.