Comparison of Efficacy of Nebulized Ketamine plus Lidocaine versus Morphine in Pain Management in Patients referred to Emergency Department: A Randomized triple-blind Clinical Trial

Pain is a common cause of patients referred to the emergency department (ED). The current study was performed to compare the efficacy of ketamine and lidocaine administration instead of intravenous morphine to alleviate acute limb pain in patients.

In the current triple-blind clinical trial, 40 included patients were divided into two separate groups. The intervention group received ketamine (5mg/kg), lidocaine (2mg/kg), and normal saline (0.1 ml/kg) intravenously (IV), while the control group received 0.1 mg/kg of morphine and nebulizer normal saline. A 10-point pain scale was performed to measure the pain level and its effects before and after treatment. At intervals of 5-60 minutes, the pain was evaluated.

The average pain relief between the two groups was not statistically different.  For the first 5-10 minutes after the drug administration, similar pain relief was observed in both groups. In the first 15 minutes, ketamine and lidocaine nebulizer pain relief was better than morphine. The reaction to pain-relieving medication in both groups was more extensive than the three numerical pain assessments. There was no noticeable adverse effect in the studied groups.

The ketamine and lidocaine nebulizers in emergency departments can be used as a practical and simple approach to managing acute limb pain. Given that lidocaine was utilized in this investigation to boost ketamine mucosal absorption and prevent probable adverse effects, more trials lacking lidocaine could be conducted to remove lidocaine's effect and better evaluate ketamine's effect. Ketamine can also be used at a higher dose to evaluate its effects and possible side effects.