Is Analgesic Effect of Low Dose Ketamine-midazolam the Same as Morphine
Is Analgesic Effect of Low Dose Ketamine-midazolam the Same as Morphine
the investigators assessed the effects of low-dose IV ketamine-midazolam versus morphine on
 pain control in trauma patients with closed limb fracture(s); and also compared the incidence
 of adverse events (mainly cardio pulmonary ) between two groups.
this prospective, single blind, noninferiority trial randomized consecutive ED patients aged
 18 to 60 years to two groups: receiving either 300-500 mcg ketamine plus 0.03 mg midazolam,
 or 0.05 to 0.1 mg morphine. Visual analogue score and adverse events were carefully verified
 during an interval of 30 minutes.

 Two hundreds, thirty six patients were selected, among whom were 207 males (87.3%), and 29
 females (12.2%). The average age was 29±2, with extremes of 60 years and 18 years.the
 patients were divided into two groups: G1: 116 patients receiving ketamine-midazolam and G2:
 120 patients receiving morphine alone.
Inclusion Criteria:

 1. Between 18 and 60 years

 2. Patients with closed limb fracture(s)

 3. VAS score of at least 6

 Exclusion Criteria:

 1. Acute pulmonary infection

 2. Previous coronary artery diseases,ACS,congestive heart failure,

 3. suspected aortic dissection

 4. History of uncontrolled hypertention or blood pressure > 140/90mmHg

 5. Brain injury with focal neurological deficit or loss of consciousness

 6. Central nervous system mass lesion,hydrocephalus, or other states with increased
 intracranial pressure

 7. Glaucoma and acute globe injury

 8. History of porphyria

 9. Previous hyperthyroidism or thyroid hormone replacement

 10. Pregnancy or laction

 11. Major psychiatric disorder

 12. Previous allergic reaction to the agents administered in the study

 13. Patient declined to provide written informed conse