دورية أكاديمية
Ketamine For Acute Pain After Trauma (KAPT): A Pragmatic, Randomized Clinical Trial.
| العنوان: | Ketamine For Acute Pain After Trauma (KAPT): A Pragmatic, Randomized Clinical Trial. |
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| المؤلفون: | Klugh JM; Department of Surgery, McGovern Medical School at UTHealth, Houston, TX., Puzio TJ; Department of Surgery, McGovern Medical School at UTHealth, Houston, TX., Wandling MW; Department of Surgery, McGovern Medical School at UTHealth, Houston, TX., Guy-Frank CJ; Department of Surgery, McGovern Medical School at UTHealth, Houston, TX., Green C; Center for Translational Injury Research, Department of Surgery, McGovern Medical School at UTHealth, Houston, TX., Sergot PB; Department of Emergency Medicine, The University of Texas Medical Center at Houston, Houston, TX., Prater SJ; Department of Emergency Medicine, The University of Texas Medical Center at Houston, Houston, TX., Balogh J; Department of Anesthesia, University of Arkansas for Medical Sciences, Little Rock, AR., Stephens CT; Department of Anesthesiology, McGovern Medical School at UTHealth, Houston, TX., Wade CE; Center for Translational Injury Research, Department of Surgery, McGovern Medical School at UTHealth, Houston, TX., Kao LS; Department of Surgery, McGovern Medical School at UTHealth, Houston, TX., Harvin JA; Department of Surgery, McGovern Medical School at UTHealth, Houston, TX. |
| المصدر: | The journal of trauma and acute care surgery [J Trauma Acute Care Surg] 2024 May 01. Date of Electronic Publication: 2024 May 01. |
| Publication Model: | Ahead of Print |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Lippincott, Williams & Wilkins Country of Publication: United States NLM ID: 101570622 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2163-0763 (Electronic) Linking ISSN: 21630755 NLM ISO Abbreviation: J Trauma Acute Care Surg Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Hagerstown, MD : Lippincott, Williams & Wilkins |
| مستخلص: | Introduction: Non-narcotic intravenous medications may be a beneficial adjunct to oral multimodal pain regimens (MMPRs) which reduce but do not eliminate opioid exposure and prescribing after trauma. We hypothesized that the addition of a sub-dissociative ketamine infusion (KI) to a standardized oral MMPR reduces inpatient opioid exposure. Methods: Eligible adult trauma patients admitted to the intermediate or intensive care unit were randomized upon admission to our institutional MMPR per usual care (UC) or UC plus sub-dissociative KI for 24 to 72 hours after arrival. The primary outcome was morphine milligram equivalents per day (MME/d) and secondary outcomes included total MME, discharge with an opioid prescription (OP%), and rates of ketamine side effects. Bayesian posterior probabilities (pp) were calculated using neutral priors. Results: A total of 300 patients were included in the final analysis with 144 randomized to KI and 156 to UC. Baseline characteristics were similar between groups. The injury severity scores for KI were 19 [14, 29] versus UC 22 [14, 29]. The KI group had a lower rate of long-bone fracture (37% versus 49%) and laparotomy (16% versus 24%). Patients receiving KI had an absolute reduction of 7 MME/day, 96 total MME, and 5% in OP%. Additionally, KI had a relative risk (RR) reduction of 19% in MME/day (RR 0.81 [0.69 - 0.95], pp = 99%), 20% in total MME (RR 0.80 [0.64, 0.99], pp = 98%), and 8% in OP% (RR 0.92 [0.76, 1.11], pp = 81%). The KI group had a higher rate of delirium (11% versus 6%); however, rates of other side effects such as arrythmias and unplanned intubations were similar between groups. Conclusion: Addition of a sub-dissociative ketamine infusion to an oral MMPR resulted in a decrease in opioid exposure in severely injured patients. Sub-dissociative ketamine infusions can be used as a safe adjunct to decrease opioid exposure in monitored settings. Level of Evidence: I; Therapeutic/Care Management. Competing Interests: Conflict of Interest: The authors report no conflict of interest involving this work. All JTACS disclosure forms have been supplied and are provided as supplemental digital content (http://links.lww.com/TA/D745). (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.) |
| معلومات مُعتمدة: | UL1 TR003167 United States TR NCATS NIH HHS |
| تواريخ الأحداث: | Date Created: 20240501 Latest Revision: 20240504 |
| رمز التحديث: | 20240504 |
| DOI: | 10.1097/TA.0000000000004325 |
| PMID: | 38689402 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 2163-0763 |
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| DOI: | 10.1097/TA.0000000000004325 |