PACKMaN

• Research type

  Research Study

• Full title

  Paramedic Analgesia Comparing Ketamine and Morphine in trauma

• IRAS ID

  1003404

• Contact name

  Gavin Perkins

• Contact email

  G.D.perkins@warwick.ac.uk

• Eudract number

  2020-000154-10

• ISRCTN Number

  ISRCTN14124474

• Research summary

  Summary of Research
  We would like to find out if ketamine is better than morphine at reducing pain in adults\nwith severe pain due to traumatic injury. Pain from severe trauma is poorly treated and\nNHS Paramedics have a limited formulary to treat severe pain. Ketamine may be an\nideal prehospital drug due to it being a safe option and quick to take effect.\nDESIGN AND METHODS: A pragmatic, blinded, controlled trial in two ambulance\ntrusts to determine the clinical and cost effectiveness of paramedic administered\nketamine and morphine, including overall pain relief, patient experience, tolerability,\nresource used and longer term outcomes.

  Summary of Results
  : Why did we do this trial?
  Pain after an injury is common. The strongest pain killer that UK paramedics are currently allowed to administer is morphine. Unfortunately, morphine can be slow to work and may cause unwanted side effects. Because of this, it may not be the best pain killer for paramedics to use. Ketamine is another drug that acts very quickly and may have fewer unwanted side effects. However, we do not know if ketamine is any better than morphine. We did this trial to find out if ketamine was better than morphine.

  What did we do?
  Paramedics from 2 Ambulance Services recruited patients who had suffered a painful injury. If the patient agreed to take part, then the paramedic administered either ketamine or morphine. Neither the paramedic nor the patient knew which drug they would get. Before and after the drug was given, the paramedics asked the patient to rate their pain on a scale from 0 to 10, where 0 was no pain, and 10 was the worst pain imaginable. We used these pain scores to work out which drug worked best to reduce the patient's pain.

  What did we find?
  Ketamine did not work better than morphine. Both drugs reduced pain by roughly the same amount. However, ketamine worked a bit faster than morphine and caused more unusual behavioural reactions than morphine. Morphine lasted a for bit longer than ketamine but was more likely to cause a drop in blood pressure and more likely to cause breathing problems.

  What do these results mean?
  Ketamine is a suitable alternative to morphine that may be a bit safer to use than morphine, but it is not more effective at reducing pain overall.
  Has the registry been updated to include summary results?: No
  If yes - please enter the URL to summary results:
  If no – why not?: We will include a link to the published results paper once available.
  Did you follow your dissemination plan submitted in the IRAS application form (Q A51)?: Yes
  If yes, describe or provide URLs to disseminated materials: Some journal publications are pending:
  Protocol - Scandinavian Journal Trauma Resuscitation and Emergency Medicine :https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Fsjtrem.biomedcentral.com%2Farticles%2F10.1186%2Fs13049-023-01146-1&data=05%7C02%7Capprovals%40hra.nhs.uk%7C7121895b342f47d3d16308dd55a7dbfb%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638760901637814466%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=HnOTpj7plFFYsoIefQ29LBjovMs2CsKg4OIsJ1QzI3U%3D&reserved=0
  Results - Lancet Regional Health
  Health Economic Analysis: Scandinavian Journal Trauma Resuscitation and Emergency Medicine Sub-group analysis by pain final score: Scandinavian Journal Trauma Resuscitation and Emergency Medicine Newly Qualified Paramedic participation: British Paramedic Journal

  Conferences:
  Trauma Care national Conference presentation Yorkshire Ambulance Service Research Symposium presentation

  Results uploaded to EudraCT.
  Link to results webpage will be provided to consented trial participants as soon as main paper is published.

  The Resus Room Podcast

• REC name

  West of Scotland REC 1

• REC reference

  20/WS/0126

• Date of REC Opinion

  14 Oct 2020

• REC opinion

  Favourable Opinion