Pilot Randomized Control Trial Comparing Oral Ketamine and Oral Oxycodone for Pain Control in Emergency Department Patients

In an effort to combat the ongoing opioid crisis, healthcare providers continue to searchfor alternatives to opioids that are both safe and effective. While no medicine has anideal profile, oral ketamine have attributes that may serve emergency department (ED)patients well when dealing with painful conditions. While IV ketamine has beenwell‐studied in the ED setting and oral ketamine has been studied in the post‐operativesetting, there is limited data describing the safety and effectiveness of oral ketaminein the ED setting. Guided by colleagues from the Anesthesia Acute Pain Service, theAlbany Medical Center (AMC) ED has begun giving oral ketamine to appropriate ED patientswith painful conditions. We aim to conduct a pilot, un‐blinded randomized controlledtrial to compare the benefits and detriments of oral ketamine vs. oxycodone in EDpatients who require 'second line' pain medicine.A convenience sample of emergency department patients will be randomized to receiveeither:Oxycodone arm:o The treating provider will order oral oxycodone 5 mg times oneoro The treating provider has made a deliberate decision that the patient requires (becauseof weight, prior exposures, etc.) greater than oxycodone 5mg times oneOral ketamine arm:o The treating provider will order ketamine 0.75 mg/kg oral times one (max 80mg)Outcomes measuredParticipants will be assessed for ‐ Pain scores at 30 and 60 minutes after either study drug administration ‐ Whether they received opioids at 6 hours, 12 hours, and 24 hours after receivingeither study drug ‐ For admitted patients, whether they received opioids upon admission to the hospital,and whether they were discharged with a prescription for opioids ‐ Whether the participation has received opioid pain medicines, ketamine, or otherrecreational drugs during the one month after enrolling in the study ‐ Whether the participation has received opioid pain medicines, ketamine, or otherrecreational drugs during the three months after enrolling in the studyWe will calculate a difference in change in mean pain scores before and after theintervention in each study arm. We will also compare morphine milli‐equivalents useduring the time intervals above, as well as usage of opioids, ketamine, and recreationaldrugs during the one month and three month period after enrollment.Because this is a pilot study, we have not calculated an effect size.