REVIEW   

Minerva Anestesiologica 2024 January-February;90(1-2):77-86

DOI: 10.23736/S0375-9393.23.17561-4

Copyright © 2023 EDIZIONI MINERVA MEDICA

language: English

A systematic review and meta-analysis comparing the efficacy and safety of ketamine versus morphine for the treatment of acute pain

Cheng SONG ¹, Dong WANG ², Bin CHEN ³ ✉

¹ Department of Anesthesiology, Affiliated Hospital of Shaoxing University, Shaoxing, China; ² Department of Anesthesiology, First People’s Hospital of Yongkang, Yongkang, China; ³ Department of Anesthesiology, Hospital of Integrated Traditional Chinese and Western Medicine of Taizhou, Taizhou, China

INTRODUCTION: Ketamine is reported as a potent opioid alternative that provides significant reduction in pain with no severe adverse events. However, some studies didn’t find its use satisfactory and reported less reduction in pain score with ketamine. The purpose of this study is to compare the efficacy and safety of ketamine versus morphine for the treatment of acute pain in emergency situations.
EVIDENCE ACQUISITION: The PubMed, MEDLINE, PsycINFO EMBASE, Cochrane Library, PROSPERO registry platform, and ClinicalTrials.gov websites were queried in accordance with the PRISMA guidelines in order to locate relevant studies. According to the predefined PICOS criteria, articles were included and event data pertaining to changes in Visual Analog Scale or Numeric Rating Scale pain scales were extracted. Using RevMan and MedCalc, a meta-analysis was conducted to compare the effects of ketamine and morphine for the treatment of acute pain.
EVIDENCE SYNTHESIS: Twelve studies met the criteria for inclusion in this meta-analysis. Ketamine was found to be more effective than morphine at reducing pain scores, with an odds ratio of 0.60 (95% CI 0.48 to 0.76). Similarly, no severe adverse events related to ketamine were reported in any study, and it has a low-risk ratio of 0.78 (95% CI 0.70 to 0.87). Egger’s Test P values (0.3052) and Begg’s Test P values (0.3869) indicate a low risk of bias, and the Bland-Altman plot demonstrates a high degree of concordance.
CONCLUSIONS: Ketamine is a potent and effective alternative to morphine for the management of acute pain, and it reduces pain score significantly with minimal side effects.

KEY WORDS: Ketamine; Morphine; Acute pain; Visual Analogue Scale; Adverse effects; Emergency treatment