357
JOURNAL OF SCIENCE, Hue University, N
0
61, 2010 EVALUATE THE EFFECTS OF KETAMINE (PAIN RELIEF DRUG) IN
PREHOSPITAL TRAUMA CARE
A CONTROLLED CLINICAL TRIAL IN QUANG TRI, VIETNAM
Tran Kim Phung
Quang Tri Health Services

SUMMARY
To compare the analgesic effect and adverse events (nausea/vomiting) of Ketamine
versus Morphine analgesia to injury patients during pre-hospital evacuations. Methods:
Patients injured in one sector get Ketamine relief (treatment group). Patients from the other
sector get Morphine (controlled group). Patient’s actual pain was assessed and rated on VAS.
The difference VAS1-VAS2 is the indicator of analgesic effect. Adverse effect (nausea/vomiting)
based on clinical assessment at the end point and interview. Results: 257 patients included of
which: 140 in Ketamine and 117 in Morphine was analysed. Significant difference between
VAS1-VAS2, p<0.0001. No significant difference of analgesic effect between Ketamine and
Morphine group, p>0.05. Analgesic effect of Ketamine is very clear in every ISS level,
regardless of male, female and age groups. Conclusions: Analgesic effect of Ketamine in
trauma care at community is clear, the same analgesic effect of Morphine. Adverse effect
(nausea/vomiting) is much lower in Ketamine than Morphine.
Key words: Analgesic effect, adverse events, pre - hospital.

1. Introduction
Efficient pain relief is crucial in primary life support for trauma victims. Acute

systematic pre - hospital trauma system in the province of Quang Tri, we want to study
the effect of ketamine analgesia in protracted evacuations.
Objectives: This study compared the analgesic effect and adverse effects of
ketamine and morphine in pre - hospital trauma care where medical resources were
scarce.
2. Methodology
Study population
Inclusion criteria
Any patient in Quang Tri Province that was injured during the study period,
regardless of type of trauma, whose pre - hospital life support was provided by trained
health workers. The patients were given medical assistance during evacuation to Quang
Tri Provincial Hospital (QT-PH), the end-point for this study.
Exclusion criteria
Refusal of analgesia by patient or patient’s family.
Deeply unconscious patients (no response to pain stimuli).
Patients who had already died on first medical contact in-field.
Patients given general or local anaesthesia in-field for invasive life-support
measures (airway cut-down, chest tube placement etc.). 359
Patients with pre - hospital evacuation time < 10 minutes.
Sampling and recruitment
A systematic cluster sampling technique was used in this study
We divided the province into two geographical sectors (“Sector 1” and “Sector
2”), each sector having approximately the same number of patients and approximately
the same transport times.
Patients injured in one sector received ketamine pain relief (Treatment Group);
patients from the other sector (the rest of Quang Tri province) received morphine pain
relief (Control Group). To reduce the impact of systematic failures, the sectors were

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= 0.20: nausea/vomit rate by morphine
p
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The study concluded when at least 125 consecutively injured patients were
included in each group (treatment group and control group), the study ended 30 March
2009.
Time schedule
The inclusion of patients started from 1 August 2007 to 1 July 2008.
Creating data for statistical analyses
The statistical analysis was performed using JMP and PEST software. The main
outcome variables (analgesic effect and adverse effect on airways) were analysed by
sequential statistics using double triangular tests.
3. Results
During the study process, a total of 320 samples was collected. Study included
257 samples. Of which : Ketamine n=140, Morphine n=117.
3.1. Matched pairs analysis by analgesia
Table 3.1. Matched pairs analysis by analgesia

VAS1 7.05 6.80 7.35 6.73 7.55 6.92
VAS2 3.70 3.69 4.22 4.09 3.89 3.65
Mean
Difference
3.35 3.11 3.12 2.65 3.66 3.27
Std Error 0.21 0.26 0.41 0.59 0.27 0.30
Upper95% 3.76 3.62 4.03 3.90 4.21 3.87
Lower95% 2.93 2.59 2.22 1.39 3.11 2.67
N 76 55 12 15 52 47
Correlation 0.08 -0.14 0.28 -0.16 0.11 0.05
t-Ratio 16.04 12.06 7.58 4.52 13.39 11.00
DF 75 54 11 14 51 46
Prob > |t| <.0001 <.0001 <0.0001 <0.0005 <.0001 <.0001
Test Across
Groups
Prob>F Prob>F Prob>F
Mean
Difference
0.47 0.53 0.33
3.3. Matched pairs analysis by Gender
Table 3.3. Matched pairs analysis by Gender
GENDER MALE FEMALE
VAS1 7.07 7.15 6.85
VAS2 3.78 3.81 3.70
Mean Difference 3.29 3.34 3.15 362
GENDER MALE FEMALE
Std Error 0.12 0.13 0.26

363
AGE <15 Ketamine Morphine Male Female
DF 20 13 6 14 5
Prob > |t| <.0001 0.0001 0.0045 0.0001 0.0068
Test Across
Groups
Prob>F F Ratio Prob>F
Mean
Difference
0.45 0.75 0.40
3.6. Matched pairs analysis by age (15-54)
Table 3.6. Matched pairs analysis by age (15-54)
Age (15-54) KETAMIN MORPHIN MALE FEMALE

VAS1 7.08 7.25 6.87 7.17 6.70
VAS2 3.81 3.80 3.82 3.83 3.73
Average
difference
3.27 3.45 3.05 3.34 2.97
Standard error

0.14 0.18 0.23 0.15 0.38
95% CI 2.99 - 3.55 3.09 - 3.82 2.60 - 3.49 3.04 -3.65

2.20 -3.74

Sample size 187 102 85 152 35
Correlation 0.018 0.13 -0.113 0.05 -0.1069
t-test 22.70 18.73 13.50 21.63 7.836
Degrees of

Sample size 49 24 25 24 25
Correlation 0.089 0.009 0.06 0.09 0.098
t-test 14.55 11.10 9.54 14.93 8.08
Degrees of
Freedom (df)
48 23 24 23 24
P
value
<.0001 <.0001 <.0001 <.0001 <.0001
Test among groups

0.95 0.41
4. Discussion
4.1.Matched pairs analysis by analgesia
In our results there was a statistically significant difference between VAS1 and
VAS2 for the total sample, as well as the individual groups: ketamine and morphine
p<0.0001. The mMean difference for the ketamine group was found to be 3.44, which
that was slightly higher than the morphine group (3.11), however, no signifcant
difference was found between the mean difference of the two groups. P = 0.1679.
It also means that: the analgesic effect of ketamine is the same as the analgesic
effect of morphine.
4.2. Matched pairs analysis by ISS level for each analgesia group
In the ketamine group, the diference between VAS
1
and VAS
2
were 3.35, 3.12
and 3.66, slightly higher in comparison to 3.11, 2.65, 3.27 in the morphine group,
respectively. But there was no significant difference in analgesia across each ISS group.
p>0.05.

of >=55 years. In the morphine group, there were 25 children- injured patients with an
age range of >=55 years.
There was a significant difference between VAS1 and VAS2 in the ketamine and
morphine groups, p<0.0001 and 0.0001 respectively, but no signifcant difference was
found between the mean difference of the two groups. p = 0.95.
5. Conclusions
A total of 257 samples during pre - hospital evacuation were collected for the
study analysis.
5.1. The analgesic effect of both ketamine and morphine were clear. There was a
statistically significant difference between VAS1 and VAS2 for the total samples as well
as the individual groups assigned to ketamine and morphine
The analgesic effect of ketamine was the same as the analgesic effect of
morphine.
No signifcant difference was found between the mean difference of the two
groups. 366
5.2. The analgesic effects of ketamine and morphine were clear by ISS, age and
gender
5.3. The adverse effects of nausea and vomiting were much lower in the
ketamine group than the morphine group (5% vs 30.77%) and (2.14% vs 27.25%),
respectively.

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