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Low-dose Ketamine for Acute Pain in the Emergency Department

29. januar 2017 opdateret af: HAJER KRAIEM, Faculty of Medicine, Sousse

Benefit of the Association of Low Doses of Ketamine With Intravenous Morphine in the Treatment of Acute Severe Pain in Emergency Department

This study aims to determine the efficacy and safety of low dose ketamine in association with IV morphine in the management of acute moderate to severe pain in emergency department.

The investigators hypothesize that low dose ketamine will result in more effective pain control than morphine alone and will not be associated with an increase in adverse events.

Studieoversigt

Status

Ukendt

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Management of pain in the Emergency Department is challenging. Treatment of pain is most often accomplished by parenteral opioids analgesics. However, the use of opioids alone for pain control is often associated with inadequate analgesia and increased adverse events.

Low-dose ketamine has been shown to improve pain perception and produce an opioid-sparing effect when given perioperatively.

Its use in the ED may probably play a role in maximizing analgesia.

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

125

Fase

  • Fase 1

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

  • Tunesien
      • Sousse, Tunesien, 4002
        • Faculty of Medicine of Sousse

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år til 65 år (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  • Able to understand and give informed consent
  • Comfortable with the experimental protocol as outlined to them by the research team
  • Severe pain, pain score of at least 50/100 on Visual Analogue Scale (VAS) or 5/10 numerical ratings score
  • Acute pain, pain duration < 7days
  • Deemed by treating ED attending physician to require IV opioid analgesia

Exclusion Criteria:

  • Neurologic, respiratory, or hemodynamic compromise
  • Pregnancy or breastfeeding
  • Known or suspected allergy to ketamine or morphine
  • Known Renal (Cr>2.0) or Liver Failure
  • Unstable psychiatric disease (as per treating physician)
  • History of stroke
  • History of cardiac disease or coronary artery disease
  • History of chronic respiratory disease

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Tredobbelt

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Aktiv komparator: Morphine and Placebo
Morphine IV, Dose: 0.1 mg/Kg followed 10 minutes later by an injection of Placebos (0.9% normal saline 0.05ml/kg)
Medicin: Morfin
Morfin
Andre navne:
  • Morfinsulfat
Medicin: Placebos
0.9% normal saline
Andre navne:
  • Normal Saline Flush, 0.9% Injectable Solution
Eksperimentel: Morphine and Ketamine 0.15
Morphine IV, Dose: 0.1 mg/Kg followed 10 minutes later by an IV bolus of Ketamine at the dose of 0.15mg/kg
Medicin: Morfin
Morfin
Andre navne:
  • Morfinsulfat
Medicin: Ketamin
ketamin
Andre navne:
  • Ketalar, 50 mg/ml injicerbar opløsning
Eksperimentel: Morphine and Ketamine 0.3
Morphine IV, Dose: 0.1 mg/Kg followed 10 minutes later by an IV bolus of Ketamine at the dose of 0.3mg/kg
Medicin: Morfin
Morfin
Andre navne:
  • Morfinsulfat
Medicin: Ketamin
ketamin
Andre navne:
  • Ketalar, 50 mg/ml injicerbar opløsning

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Efficacy of analgesia: To assess the primary outcome of pain relief, we used patient-reported pain scores. We consider the pain decreasing of at least 50% of pain score and the summed pain-intensity difference (SPID) over 2 hours
Tidsramme: Two hours after starting protocol

At baseline, to assess our primary aim, efficacy of pain control, we will use patient reported pain scores and amount of rescue analgesia (parenteral morphine) received. Trained residents will ask participants to report their pains scores using a numerical pain rating scale (NPRS). The NPRS used will be a 0 to 10 rating scale. Baseline NPRS will be measured after randomization, but just before administration of morphine. Change in reported pain score during the protocol will be analysed.

The SPID was calculated using the pain-intensity difference (PID) at each of these study time points. The PID for a given time point is equal to the baseline NPRS minus the subsequent NPRS at each study time point. SPID is the summation of the PID at each of the study time points, weighted using the amount of time since the prior assessment
Two hours after starting protocol

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Total patient-perceived pain relief
Tidsramme: Two hours after starting protocol
The total patient-perceived pain relief will be calculated using weighted sum of the pain relief scale performed at each study time point. This pain relief scale is a five-point scale that asks participants to rate pain relief as complete = 4, a lot = 3, some = 2, a little = 1, and none = 0
Two hours after starting protocol
Amount of rescue analgesia received
Tidsramme: Two hours after starting protocol
The amount of rescue analgesia received (in milligrams of morphine equivalents) will be recorded.
Two hours after starting protocol
Time to rescue analgesia
Tidsramme: Two hours after starting protocol
Time to rescue analgesia will be calculated as the time from administration of the last study medication (placebo or ketamine) to administration of an opioid analgesic.
Two hours after starting protocol
The occurrence of adverse events
Tidsramme: Two hours after starting protocol

We will record participant-reported dizziness, nausea, vomiting, confusion, dysphoria, visual disturbances, or other complaints at baseline and each study time point. All patients will be monitored for the duration of the study period and vital signs will be recorded at each time point.

The presence of tachycardia (heart rate > 100 beats/min.), hypotension (systolic blood pressure [sBP] < 100 mm Hg), hypertension (sBP > 180 mm Hg or diastolic blood pressure [dBP] > 100 mm Hg), and respiratory depression (respiratory rate < 12 breaths/min, oxygen saturation < 92%, or need for supplemental oxygen) will be noted.
Two hours after starting protocol
The total dose of morphine administered
Tidsramme: Two hours after starting protocol
The amount of rescue analgesia will be recorded at each time point and the total dose calculated
Two hours after starting protocol

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Faculty of Medicine, Sousse

Efterforskere

  • Ledende efterforsker: Hajer KRAIEM, MD, Faculty of Medicine of Sousse

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart

1. januar 2016

Primær færdiggørelse (Faktiske)

1. juni 2016

Studieafslutning (Forventet)

1. marts 2017

Datoer for studieregistrering

Først indsendt

9. januar 2017

Først indsendt, der opfyldte QC-kriterier

9. januar 2017

Først opslået (Skøn)

11. januar 2017

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Skøn)

31. januar 2017

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

29. januar 2017

Sidst verificeret

1. januar 2017

Mere information

Begreber relateret til denne undersøgelse

Nøgleord

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • FMSousse

Plan for individuelle deltagerdata (IPD)

Planlægger du at dele individuelle deltagerdata (IPD)?

UBESLUTET

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