Ketamine Infusion for Pain Control in Adult Patients with Multiple Rib Fractures: Results of a Randomized Control Trial

Introduction Rib fractures occur in up to 40% of trauma patients and are associated with increased mortality. Opiate-based pain regimens remain the cornerstone of rib fracture management; however, concerns around opioids have fostered interest in alternative analgesics. Ketamine is currently being used in lieu of opioids, but little evidence exists supporting its use within the trauma population. Methods A prospective, randomized, double-blind placebo-controlled trial of adult patients with ≥3 rib fractures admitted to a Level 1 trauma center was conducted. Exclusion criteria included age >64 years, GCS 15) demonstrated that LDK was associated with a significant reduction in OME utilization during the first 24-hours (35.7 vs. 68, p=0.03), 24-48 hours (64.2 vs 96, p=0.03), and overall (152.1 vs 198, p=0.048). No difference in other secondary outcomes or adverse events was noted. Conclusion LDK failed to decrease NPS or OME within the overall cohort, but a decrease in OME was observed among patients with an ISS >15. Confirmatory studies are necessary to determine if LDK is a useful adjunct among severely injured patients. Level of Evidence I Study Type Therapeutic Meeting Presentation: 77th Annual Meeting of the American Association for Surgery of Trauma, September 26-29, 2018 in San Diego, California Corresponding Author: Thomas W Carver MD, FACS, Societal Memberships: AAST and WTA, Medical College of Wisconsin, Department of Surgery, Division of Trauma and Acute Care Surgery, 8701 Watertown Plank Rd., Milwaukee, Wisconsin 53226 United States, Cell: 1 (847) 977-4896, Office: 1 (414) 955-1733, Fax: 1 (414) 955-0072 Conflict of Interest Statement: There are no conflicts of interests to report for any of the authors of this study. Source of Funding: This trial was funded through institutional grant funding (Research Affairs Committee Grant #3307034). Financial Disclosures: Drs. Carver and Kugler are paid consultant for InnoVital Systems Inc. The remaining authors have no financial disclosures. Disclosure: None of the authors have any financial and personal relationships with other people or organizations that could potentially and inappropriately influence their work and conclusions on this topic. © 2018 Lippincott Williams & Wilkins, Inc.

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