LAS VEGAS – Ketamine infusion therapy may not effectively reduce opioid consumption in patients with rib fractures as a result of blunt chest trauma, although more research is needed to determine the benefits of ketamine in this patient population, according to study results presented at PAINWeek 2019 held September 3-7 in Las Vegas, Nevada.
The study included patients who were admitted to a level one trauma center with any number of rib fractures (n=428). Participants with an initial Glasgow Coma Scale score ≤8, an Injury Severity Score ≥25, and who were under 18 years of age were excluded from the study, for a total of 376 participants.
Data on participants’ age, sex, race, body mass index, length of stay, number of rib fractures, mechanism of injury, history of substance abuse, medication administration, and opiate use prior to hospitalization were collected. Opiate administration was determined using medication administration records, and doses were converted into oral morphine equivalents (OMEs) using standard conversion rates. A total of 14 participants (4%) received ketamine infusion in addition to opioids.
The participants who received ketamine had a median OME of 124.5 (range: 36.9-288.7) compared with 30 for patients treated with opioids only (range: 0-395). However, because of the small sample size of the ketamine group, this difference was not statistically significant.
Participants with vs without a history of chronic pain were found to consume greater quantities of opioids (OME: 51.3 vs 30, respectively; P <.02), and those with vs without a history of opiate use or substance abuse prior to hospital admission had lower OMEs (opiate use: 46.4 vs 30, respectively; P <.004; substance abuse: 45 vs 300, respectively; P <.001).
A moderate positive correlation was established between greater Injury Severity Scores and increased OME needs (r=0.25; P <.0001).
“By avoiding respiratory and cardiovascular compromise, ketamine may be a safer alternative treatment modality compared [with] opioids in managing pain associated with rib fractures secondary to blunt force traumatic injury,” noted the researchers.
Alban H, Green A, Du E. Ketamine infusions: an opioid reduction strategy in trauma patients with rib fractures. Poster presented at: PAINWeek 2019 Conference; September 3-7, 2019; Las Vegas, NV. Poster 37.