Comprehensive Summary
This multicenter, double-blind, randomized clinical trial (RCT) evaluated the analgesic efficacy of intravenous (IV) ketamine versus ketorolac in adult patients presenting with chest trauma. Ninety patients were randomized in a 1:1 ratio to receive either 0.25 mg/kg IV ketamine or 30 mg IV ketorolac treatment. Pain intensity was assessed using a numeric rating scale (NRS) before and 30 and 60 min. after drug administration. Morphine served as rescue medication according to standardized institutional protocols. Safety was assessed by systematic adverse event (AE) rating during the study period. Ketamine produced significantly greater pain reduction compared with ketorolac at both 30 min. (median NRS: 3.0 vs. 5.0; p=0.006) and 60 min. (NRS: 3.0 vs. 5.6; p<0.001) post-drug injection. Subgroup analysis of patients with chest tubes demonstrated superior pain control with ketamine at both timepoints (p<0.001). Furthermore, ketamine administration was associated with decreased use of rescue morphine, but a higher incidence of nausea compared with ketorolac.
Outcomes and Implications
Effective pain management in chest trauma patients remains challenging, particularly given the use of current analgesics such as NSAIDs and opioids is limited by adverse effects. Low-dose ketamine emerges as a potentially effective alternative. This study demonstrates that low-dose ketamine provides superior analgesic efficacy compared with ketorolac in patients with chest trauma. Limitations include the potential confounding effect of concomitant injuries, absence of long-term pain and AE follow-up, and the lack of a placebo-controlled or double-dummy design. Larger multicenter RCTs are warranted to validate these findings, characterize ketamine’s AE profile, and assess its impact on long-term patient-centered outcomes.