Page 88 - JSOM Spring 2023

TABLE 1 Different Medications Used in the IN Group and the the VAS, whereas W-BFPRS is more subjective and less precise.
SC/IV Group The information about analgesia was found retrospectively on
N ISS casualty cards, many of which were not fully completed. Fur-
(%) (Mean, Min; Max) thermore, mortality among this cohort was not evaluated due
IN Group 76 (28.2; 1; 75) to the lack of follow-up due to quick evacuation to the local
IN Ketamine + SC Morphine civilian hospital. The IN group’s patient severity is generally
10mg 50 (65.8) (30; 4; 75) heavier than the IV/SC group, with a greater ISS (p ≤ .05).
IN Ketamine only 9 (11.8) (14.2; 1; 32) Consequently, the difference in dose of additional IV doses of
IN Ketamine + SC Morphine 8 (10.5) (29.5; 9; 50) morphine and ketamine in the IN group and the IV/SC Group
10mg + IV Ketamine is not significative with a student’s t-test due to the small popu-
IN Ketamine + IV Morphine 5 (6.6) (9; 4; 9) lation. Finally, the population in this series is not large enough
IN Ketamine + IV Ketamine 4 (5.3) (50; 9; 75) to perform a powerful statistical analysis, therefore prospec-
SC/IV Group 64 (16.4; 1; 75) tive studies are necessary to confirm the results.
SC Morphine 10mg only 33 (51.6) (17.8; 25; 1)
SC Morphine 10mg + IV Conclusion
Morphine + IV Ketamine 12 (18.7) (25.3; 9; 75)
IV Ketamine only 11 (17.8) (24; 8; 41) IN ketamine appears to be of great interest for the pain man-
agement of combat casualties. In an austere environment or in
IV Morphine only 3 (4.7) (17; 9; 34) case of massive casualties where the IV route can be challeng-
SC Morphine 10mg + IV 3 (4.7) (23.5; 13; 34) ing, IN administration of ketamine 50mg could be effective,
Ketamine alone or in addition to other analgesics, and could reduce the
SC Morphine 10mg + IV 2 (3.1) (21.5; 34; 9) doses of ketamine and morphine used by the IV route. The
Morphine
IN = intranasal, SC = subcutaneous, IV = intravenous French Military Medical Service supports current develop-
ments for personal devices delivering individual doses of IN
TABLE 2 Comparison of Mean ISS and Average Additional Doses in ketamine. However, further studies are needed to analyze its
the IV and SC/IV Groups
efficacy and safety in combat zones.
SC/IV Student’s
IN Group Group test Disclosure
N 76 64 None.
Mean ISS 28.2 16.4 <0.05
Average additional dose Funding
IV Morphine (mg) 3 6.2 0.16 None.
IV Ketamine (mg) 34.3 47.3 0.23 References
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5 to 20 minutes to achieve a visual analog scale (VAS) pain 3. Lemoel F. Gestion de la douleur traumatique en urgence par voie
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86 | JSOM Volume 23, Edition 1 / Spring 2023