This study evaluated the effects of ketamine versus morphine for prehospital pain relief in trauma patients in Vietnam. 257 patients were included, with 140 receiving ketamine and 117 receiving morphine. Ketamine provided equivalent pain relief to morphine based on differences in pre- and post-treatment pain scores, with significantly lower rates of nausea and vomiting. The study concluded that ketamine is an effective alternative to morphine for prehospital pain relief with fewer adverse effects.

1. Evaluate the Effects of Ketamine (Pain Relief Drug) in prehospital trauma care: A controlled clinical trial in Quang Tri, Vietnam Dr. PhD. Tran Kim Phung Co-operation between TMC, Oslo University and Quang Tri Health Service

16. Significant difference between VAS1 and VAS2, P<0.0001 No significance between the mean difference across ketamine and morphine group, P>0.05 Matched Pairs (Difference VAS1-VAS2) P= 0.1679 Test across group <.0001 <.0001 <.0001 Prob > |t| 117 140 257 N 2.75 - 3.48 3.14 - 3.75 3.06 - 3.53 95% CI 0.18 0.16 0.12 Std Error 3.11 3.44 3.29 Mean Difference 3.72 3.82 3.78 VAS2 6.84 7.26 7.07 VAS1 Morphine Ketamine

17. Significant difference between VAS1 and VAS2 in each ISS group, p<0.001 <.0001 <.0001 <.0001 Prob > |t| 99 27 131 N 3.07 - 3.87 2.10 - 3.62 2.93 - 3.56 95% CI 0.20 0.37 0.16 Std Error 3.47 2,86 3.25 Mean Difference 3.78 4.15 3.70 VAS2 7.25 7.01 6.95 VAS1 Sev ere M ajor Mod erate

18. Significant difference between VAS1 and VAS2 in each group , No significance difference between the mean difference across Ketamine and morphine group in ISS 0.33 0.47 0.53 Mean Difference Prob>F Prob>F Prob>F Test Across Groups <.0001 <.0001 <.0001 <.0001 0.0005 <.0001 Prob > |t| 47 52 55 76 15 12 N 2.67 3.11 2.59 2.93 1.39 2.22 Lower95% 3.87 4.21 3.62 3.76 3.90 4.03 Upper95% 0.30 0.27 0.26 0.21 0.59 0.41 Std Error 3.27 3.66 3.11 3.35 2.65 3.12 Mean Difference 3.65 3.89 3.69 3.70 4.09 4.22 VAS2 6.92 7.55 6.80 7.05 6.73 7.35 VAS1 Morphine Ketamine Morphine Ketamine Morphine Ketamine Severe Moderate Major ISS group

19. Significant difference between VAS1 and VAS2 in each group , No significance between the mean difference across male and female group, p>0.05 0.16 Mean Difference Prob>F Test Across Groups <.0001 <.0001 <.0001 Prob > |t| 66 191 257 N 2.62 3.08 3.06 Lower95% 3.67 3.61 3.53 Upper95% 0.26 0.13 0.12 Std Error 3.15 3.34 3.29 Mean Difference 3.70 3.81 3.78 VAS2 6.85 7.15 7.07 VAS1 FEMALE MALE GENDER

20. 6 15 7 14 21 n P=0.40 P=0.45 Mean Difference Test Across Groups 0.0068 0.0001 0.0045 0.0001 <.0001 Prob > |t| 1.54 1.65 1.13 1.98 2.11 Lower95% 5.77 3.94 3.95 4.60 3.97 Upper95% 0.82 0.53 0.58 0.61 0.45 Std Error 3.65 2.79 2.54 3.29 3.04 Mean Difference 3.82 4.28 4.4 4.02 4.15 VAS2 7.47 7.07 6.94 7.31 7.19 VAS1 Female Male Morphine Ketamine AGE < 15

22. 1.021 0.173 Mean Difference F Ratio Prob>F Test Across Groups <.0001 <.0001 <.0001 <.0001 <.0001 Prob > |t| 35 152 85 102 187 N 2.20 3.04 2.60 3.09 2.99 Lower95% 3.74 3.65 3.49 3.82 3.55 Upper95% 0.38 0.15 0.23 0.18 0.14 Std Error 2.97 3.34 3.05 3.45 3.27 Mean Difference 3.73 3.83 3.82 3.80 3.81 VAS2 6.70 7.17 6.87 7.25 7.08 VAS1 FEMALE MALE MORPHINE KETAMINE Age (15-54)

24. 0.41 0.95 Mean Difference Prob>F Prob>F Test Across Groups <.0001 <.0001 <.0001 <.0001 <.0001 Prob > |t| 25 24 25 24 49 N 2.45 3.18 2.74 2.82 3.00 Lower95% 4.13 4.20 4.26 4.12 3.97 Upper95% 0.41 0.25 0.37 0.32 0.24 Std Error 3.29 3.69 3.5 3.47 3.48 Mean Difference 3.63 3.35 3.21 3.78 3.49 VAS2 6.91 7.04 6.71 7.25 6.98 VAS1 FEMALE MALE MORPHINE KETAMINE AGE>=55

26. Significantly difference between nausea and/ or vomit with much higher rate in morphine group, P<0.0001 20 27.35 32 30.77 36 MORPHINE n=117 0 0 2.14 3 5.00 7 KETAMINE n=140 Percent Nausea & vomit Percent Vomit Percent Nausea

27. B. Agreement analysis VAS2 & VAS3 -0.08 - 0.08 -0.11 Agreement index (AI)=1- 2SD (Dif) / mean level 8/117= 6.8% 7/140= 5.7% 11/257 = 4.3% Percentage (%) outliers 4.48 4.08 4.36 Agreement limit (2SDdiff ) -0.82 0.08 -0.32 Mean difference 4.13 3.78 3.92 Mean level Morphine Ketamine Statistics Parameters