Ketamine may reduce positional pain more than dexmedetomidine or nerve block in femur fracture patients

This randomized controlled trial enrolled 75 patients (ASA Grade I-III, aged 18-80 years) with femur fractures scheduled for elective surgery. It compared three analgesic techniques for alleviating positional pain before spinal anesthesia: intravenous ketamine 0.3 mg/kg (Group K, n=25), intravenous dexmedetomidine 0.5 μg/kg (Group D, n=25), and femoral nerve block (Group C, n=25). The primary outcome was analgesic efficacy, with secondary outcomes including patient satisfaction, quality of positioning, time to perform spinal anesthesia, hemodynamics, and sedation.

Pain scores and patient satisfaction scores significantly decreased in all three groups. However, the abstract reports that both pain scores and patient satisfaction scores were 'much significantly lower' in the ketamine group compared to the dexmedetomidine and femoral nerve block groups. The specific quantitative data—including mean scores, effect sizes, absolute numbers, p-values, and confidence intervals—for these outcomes are not reported in the provided text.

No safety, tolerability, or adverse event data are reported for any intervention. The study's limitations are not specified in the abstract, and funding or conflict of interest information is not reported. The absence of quantitative results makes it difficult to assess the magnitude of benefit or clinical significance of the reported differences.

For practice, this single, small RCT suggests intravenous ketamine 0.3 mg/kg might be more effective than intravenous dexmedetomidine or a femoral nerve block for this specific procedural pain indication. However, clinicians should interpret these findings cautiously due to the lack of reported numerical data, unknown safety profile in this context, and absence of information on clinically important outcomes like time to anesthesia or hemodynamic stability.