Morphine or Ketamine for Analgesia

NCT ID: NCT06835504

Last Updated: 2026-01-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

PHASE3

Total Enrollment

1010 participants

Study Classification

INTERVENTIONAL

Study Start Date

2026-05-01

Study Completion Date

2029-10-31

Brief Summary

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Pain is common in children presenting to the emergency department but is frequently undertreated, leading to both short- and long-term consequences. Morphine is the standard treatment for children with moderate to severe acute pain, but its use is associated with serious side effects and caregiver and clinician concerns related to opioid administration. The investigators aim to determine if sub-dissociative ketamine is non-inferior to morphine for treating acute pain and a preferable alternative for treating acute pain in children because of its more favorable side effect profile and potential long-term benefits related to pain-related function, analgesic use/misuse, and mental and behavioral health outcomes.

Detailed Description

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Aim 1: To determine if IV sub-dissociative ketamine is non-inferior to IV morphine for decreasing pain intensity in children presenting to an ED with acute pain. The investigators hypothesize that IV sub-dissociative ketamine is non-inferior to IV morphine for decreasing pain intensity in children with acute abdominal pain or an extremity fracture.

Aim 2: To compare the rate of acute (\<2 hours) adverse events, including cardiopulmonary adverse events, associated with IV sub-dissociative ketamine and IV morphine. The investigators hypothesize that there is a smaller proportion of cardiopulmonary adverse events associated with IV sub-dissociative ketamine compared to IV morphine.

Aim 3: To determine the relationship between ketamine and long-term sequelae of acute pain. The investigators hypothesize that children who receive ketamine will have better levels of pain-related function during the first week following ED presentation and will have greater odds of experiencing more favorable post-traumatic stress, anxiety and depression outcomes 1-6 months after ED presentation compared to children who received IV morphine.

Conditions

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Abdominal Pain Isolated Extremity Fracture Pain Pediatrics

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Non-inferiority trial design
Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Sub-dissociative ketamine

0.25 mg/kg, maximum dose 25 mg

Group Type EXPERIMENTAL

Ketamine hydrochloride

Intervention Type DRUG

Sub-dissociative ketamine, IV

Morphine

0.1 mg/kg, maximum dose 8 mg

Group Type ACTIVE_COMPARATOR

Morphine sulphate

Intervention Type DRUG

Morphine, IV

Interventions

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Ketamine hydrochloride

Sub-dissociative ketamine, IV

Intervention Type DRUG

Morphine sulphate

Morphine, IV

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

1. Abdominal pain or isolated long-bone extremity fracture (suspected or proven)
2. Self-reported pain score of ≥ 6/10
3. Requires IV morphine for analgesia as determined by the treating physician

Exclusion Criteria

1. Weight \> 82.4 kg
2. Known allergy/contraindication to morphine or ketamine
3. Antecedent receipt of ketamine related to presenting complaint
4. Inability to use self-report measures of pain or questionnaires
5. Chronic disease associated with pain
6. Chronic pain condition requiring use of opioids as outpatient
7. Hemodynamic instability or critical illness per treating physician
8. Altered mental state (e.g., GCS , 14 or clinical intoxication)
9. Known history of schizophrenia, liver or kidney problems, or osteogenesis imperfecta
10. Concern for open fracture, neurovascular compromise, or compartment syndrome
11. Injuries in addition to the extremity injury (e.g., head, neck, abdomen)
12. Known or reported pregnancy
13. Does not speak English or Spanish
14. Patient previously enrolled in this study
15. Wards of state, foster children, or children in custody
Minimum Eligible Age

6 Years

Maximum Eligible Age

17 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

NIH

Sponsor Role collaborator

National Institute of Neurological Disorders and Stroke (NINDS)

NIH

Sponsor Role collaborator

Columbia University

OTHER

Sponsor Role lead

Responsible Party

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Daniel S Tsze, MD, MPH

Professor of Pediatrics in Emergency Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Daniel S Tsze, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

Columbia University

Amy L Drendel, DO, MS

Role: PRINCIPAL_INVESTIGATOR

Medical College of Wisconsin

Locations

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Children's Hospital Los Angeles

Los Angeles, California, United States

Site Status

UC Davis Children's Hospital

Sacramento, California, United States

Site Status

Nemours Children's Hospital

Wilmington, Delaware, United States

Site Status

Arthur M. Blank Hospital

Atlanta, Georgia, United States

Site Status

NewYork Presbyterian Morgan Stanley Children's Hospital

New York, New York, United States

Site Status

UPMC Children's Hospital of Pittsburgh

Pittsburgh, Pennsylvania, United States

Site Status

Seattle Children's Hospital

Seattle, Washington, United States

Site Status

Children's Wisconsin

Milwaukee, Wisconsin, United States

Site Status

Countries

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United States

Central Contacts

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Daniel S Tsze, MD, MPH

Role: CONTACT

917-375-2647

Amy L Drendel, DO, MS

Role: CONTACT

Facility Contacts

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Deborah Liu, MD

Role: primary

323-660-2450

Leah Tzimenatos, MD

Role: primary

800-282-3284

Amy Thompson, MD, MSCR

Role: primary

302-651-4200

Becky Burger, MD

Role: primary

404-785-5437

Claudia R Morris

Role: backup

Daniel S Tsze, MD, MPH

Role: primary

212-305-6628

Raquel Shrager

Role: backup

Maren Lunoe, MD

Role: primary

412-692-5325

Bob Hickey, MD

Role: backup

Eileen Klein, MD, MPH

Role: primary

206-987-8811

Amy L Drendel, DO, MS

Role: primary

877-266-8989

Other Identifiers

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U01HD116253

Identifier Type: NIH

Identifier Source: secondary_id

View Link

IRB00181652

Identifier Type: OTHER

Identifier Source: secondary_id

AAAV7115

Identifier Type: -

Identifier Source: org_study_id

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