• Hossein Zabihi Mahmoodabadi, Zeynab Seyed Javadein, Fatemeh Moosaie, Ali Faegh, and Maryam Bahreini.
• Fellowship in Advanced Minimally Invasive and Bariatric Surgery, Tehran University of Medical Sciences, Tehran, Iran.
• Acad Emerg Med. 2024 Dec 31.

BackgroundPain management is a critical part of treatment in patients with chest trauma. Opioids and nonsteroidal anti-inflammatory drugs have been the most commonly used medications. However, their side effects have drawn attention to other medications. In this study, we aimed to assess the effect of the analgesic dose of ketamine in patients with chest trauma in comparison to ketorolac.MethodsA randomized, double-blind clinical trial was conducted in three hospitals. Patients were randomly allocated into two groups: 45 in the ketorolac group (30 mg intravenous [IV] and 45 in the ketamine group [0.25 mg/kg IV]). Pain was rated via numeric rating scale (NRS) before and 30 and 60 min after the drug injection. Morphine was used as the rescue medication. Furthermore, the adverse events of the two study regimens were rated.ResultsPain was more significantly relieved in the ketamine group, 30 and 60 min after drug administration, compared to ketorolac (median [IQR] 95% CI 30-min NRS 3.0 [1.0] 2.8-3.5 vs. 5.0 [4.5] 4.2-5.8, p = 0.006; and 60-min NRS 3.0 [2.0] 2.7-3.7 vs. 5.6 [1.7] 4.7-6.4, p < 0.001), respectively. Among patients with a chest tube, pain was more significantly controlled in the ketamine group (p < 0.001). Also, patients in the ketamine group needed less rescue pain medications compared to the ketorolac group although they reported more frequent nausea.ConclusionKetamine can be an effective analgesic in patients with chest trauma in acute settings with or without rib fracture.© 2024 The Author(s). Academic Emergency Medicine published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine.

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