ANALGESIA FOR ACUTE MUSCULOSKELETAL TRAUMA - LOW-DOSE SUBCUTANEOUS INFUSION OF KETAMINE

Low-dose ketamine by subcutaneous infusion (0.1 mg/kg/h) was compared in double-blind fashion with intermittent morphine (0.1 mg/kg intraven ously, four-hourly) as analgesic regimen in 40 ASA-I adults after acut e musculoskeletal trauma. Pain was assessed using visual analogue scal es and sedation was graded on a four point rank drowsiness score. Obje ctive cardiovascular and respiratory parameters and patient acceptabil ity in terms of supplementary analgesia and early mobilization were al so recorded. Pain relief was better with the ketamine infusion than wi th intermittent morphine (P<0.001). Patients were more awake and alert with ketamine infusion as evidenced by the drowsiness score (P<0.001) . Peak expiratory flow rate improved significantly with the ketamine i nfusion (P<0.05). None of the patients in ketamine group required supp lementary analgesia (P<0/001) and the patients could be easily mobiliz ed for traction/splintage as compared with patients in the control gro up (P<0.001). The incidence of nausea and vomiting in the morphine gro up was high (P<0.01). The study shows that subcutaneous infusion of ke tamine provides safe and effective analgesia in acute musculoskeletal trauma.