Comparison of the analgesic effect of nebulized ketamine versus intravenous morphine in controlling acute pain in patients coming to the emergency department; A randomized controlled clinical trial.

Comparison of analgesic effect of nebulized ketamine versus intravenous morphine in patients coming to the ER with acute pain.

Randomized, controlled, double blinded clinical trial, phase 3 designed for 84 patients. Randomization performs with block randomiation.

This study will be performed on patients coming to the Emergency room of Golestan hospital of Ahvaz, complaining of acute pain. The ER doctor will order nebulized Ketamine and infusion of normal saline serum in the case group and intravenous Morphine and nebulized sterile water in the control group. The researcher and the patient don't have any information about the treatment. After the patient got the analgesic drug, the researcher will ask about the level of the pain in decided minutes.

The condition to enter the study consists of the patients coming to the ER with acute pain greater than 7 out of 10 estimated by visual analogue scale. The conditions not to enter the study are; having mental illness mentioned by the patient; head trauma; ischemic heart disease; acute heart failure; respiratory distress; systolic blood pressure higher than 180 mmHg or less than 90 mmHg; asthma; high intracranial pressure; pregnancy; addiction; inability to describe pain; severe pain and need to use more than one dose of the drugs or need to change the drug; using analgesic drug before admission or history of allergy to ketamine or morphine.

Patients with acute pain coming to the emergency department.

Pain relief

At first, the decided drug orders will be written on separate sheets to a certain number and then they will be placed in sealed envelopes and randomly numbered. Then the pockets will be offered to the emergency department doctor so that he can order the analgesic drug based on the order of each pocket. The researcher has to record the patient's name in a separate table along with the number of the pocket and after concluding the data collection, this table will be checked and compared to the numbers and names written on each pocket.

Behind the researcher confirms the inclusion criteria and randomly chooses the sample, the patient will be presented to the emergency department doctor to enter the study.The researcher offers the doctor a pocket that has the method of study, and the doctor has to order the analgesic drugs according to the instruction and then covertly write down and record the patient's name in the pocket of related intervention. The doctor also can not give any information about the the drug to the researcher and the patient. In the case group, 1.5 mg per kg of Ketamine will be diluted in 5 ccs of sterile water and nebulized in 5 minutes, and also 100 ccs of Normal saline serum will infuse intravenously for 15 minutes, and in the in control group 0.1 mg per kg Morphine sulfate will be infused intravenously in 100 ccs of Normal saline and also 5 ccs of sterile water will be nebulized; in order to make the trial double-blinded. After prescribing the analgesic drug, the researcher records the patient's name and Visual Analogue Scale in decided minutes on another sheet and table. After concluding the data collection, the recorded data from the pockets and the researcher's table will be conformed to perform the data analysis.