A Comparative study of the administration of a single bolus of ketamine versus bolus administration followed by continuous infusion in the management of traumatic limb pain in a low income country

Abstract

Introduction 
 Ketamine has proven its analgesic efficacy in the management of pain due to limb trauma. There is still doubt about how to integrate ketamine into medical practice in emergency departments, including continuous infusion and bolus. The aim of this study is to compare the efficacy of ketamine administered in a single bolus with ketamine administered in a bolus relayed by a continuous infusion on traumatic limb in a context of under-equipment
 Methods
 This was a randomized, double-blind clinical trial. It took place at Ouahigouya teaching hospital over a three-month period. Any adult patient aged 18 to 65 admitted to the emergency room for limb trauma with severe pain ≥ 7 on a numerical scale (EN) was included in the study. Patients were randomized into two groups. Group 1 received a bolus of ketamine relayed by continuous infusion and group 2 received a bolus of ketamine relayed by isotonic saline infusion. The main endpoint was total morphine consumption at the end of treatment (maximum 60 minutes).
 Results
 A total of 66 patients were included; 33 in each group. The groups were statistically comparable. There was no significant difference between the two groups in morphine requirements. Indeed, 27.27% of Group 1 patients and 21.21% of Group 2 patients used morphine to relieve their pain (p = 0.29).The average dose of morphine received at the end of management (T + 60 minutes) was 6 ± 2.6 mg in Group 1 and 5.14 ± 1.46 mg in Group 2. There was no significant difference between these doses (p = 0.44). No serious side effects were noted in either group. The patient satisfaction index was on average 7.24 ± 0.75 and 7.3 ± 0.77 respectively in Group 1 and 2 (not significant difference p = 0.74).
 Conclusion
 The administration of ketamine as a single bolus is as effective as the bolus followed by continuous infusion. It is therefore up to practitioners to develop protocols for the safe use of this molecule, which will undoubtedly contribute to improving pain management in emergency departments, especially those in low income countries.