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Le Cornec C, et al. compared intravenous ketamine (20 mg, followed by 10 mg every 5 minutes) with intravenous morphine sulfate (2–3 mg every 5 minutes) in 251 adult patients with out-of-hospital traumatic pain and a verbal pain score ≥5. The mean reduction in pain score at 30 minutes was –3.7 in the ketamine group versus –3.8 in the morphine group, with a difference of 0.1 (95% CI –0.7 to 0.9), demonstrating noninferiority within the prespecified margin of 1.3. Although adverse effects were more frequent with ketamine (40.8% vs. 16.8%), primarily emergence phenomena, none required intervention.
Fig. 1 Study flow diagram (Le Cornec C, et al., 2024)
References
Ofoegbu A, et al. summarized current knowledge regarding genetic polymorphisms affecting morphine pharmacokinetics and pharmacodynamics, explaining interindividual variability in treatment outcomes. The review highlights key genes including UGT2B7 (encoding the enzyme responsible for morphine glucuronidation), OCT1 (an organic cation transporter involved in hepatic uptake), ABCB1 (encoding P-glycoprotein, which affects drug distribution), and OPRM1 (encoding the mu-opioid receptor). Variations in these genes can significantly alter morphine metabolism, transport, and receptor binding, potentially leading to differences in analgesic efficacy and adverse effects.
Fig. 2 Morphine metabolism. (Ofoegbu A, B Ettienne E, et al, 2021)
References
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