Article Text

Download PDFPDF
Journal update monthly top five
  1. Ashleigh Trimble1,
  2. Bethany Sampson1,
  3. Charlotte Grace Underwood1,
  4. Roshan Cherian1,
  5. Fiona McDonald1,
  6. Victoria Webster1,
  7. John Shepherd1,
  8. James David van Oppen1,2
  1. 1 Emergency Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  2. 2 Centre for Urgent and Emergency Care Research, The University of Sheffield, Sheffield, UK
  1. Correspondence to Dr Ashleigh Trimble, Emergency Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; a.trimble{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

This month’s update comes from the Emergency Department at Northern General Hospital, Sheffield. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper.

  • Worth a peek—interesting, but not yet ready for prime time.

  • Head turner—new concepts.

  • Game changer—this paper could/should change practice.

A non-inferiority randomised controlled trial comparing nebulised ketamine to intravenous morphine for older adults in the emergency department with acute musculoskeletal pain. Kampan et al

Topic: Analgesia

Outcome rating: Head turner

Inadequate management of acute pain in older adults contributes to adverse outcomes including decline in mobility, cognition and mood. Effective analgesia is important but must consider the physiological changes associated with ageing that affects pharmacokinetics. Although opioids are effective, they do have undesirable effects.

This study compared the analgesic efficacy and safety of nebulised ketamine to intravenous morphine in older patients.1 This non-inferiority, double-blind, randomised control trial was carried out in a tertiary centre in Thailand. Final analysis included 92 patients aged ≥65 years presenting to the emergency department with acute, moderate-to-severe musculoskeletal pain, including superficial injuries and limb fractures. An 11-point numeric rating scale (NRS) was used to measure pain levels.

There was no significant difference in mean NRS between the nebulised ketamine and intravenous morphine groups (5.2 vs 5.7) at 30 min. The comparative mean difference in the NRS change from baseline between nebulised ketamine and intravenous morphine was 0.2 (95% CI −0.49 to 0.89), which did not exceed the non-inferiority margin of 1.3. Results were comparable at other time points between 15 min and 120 min. There was also no significant difference between the two groups in use of rescue therapy or vital signs. Side effects, particularly nausea and dizziness, …

View Full Text


  • X @J_vanOppen

  • Contributors AT, BS, CU, RC, FM, VW, JS and JDvO screened citations, selected studies for inclusion and prepared the summaries.

  • Funding This study was funded by National Institute for Health and Care Research Clinical Lectureship (James van Oppen).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer-reviewed.