Morphine vs Ketamine for Prehospital Traumatic Pain: Which Is More Effective?

Compared with morphine, ketamine is not a more effective analgesia for prehospital pain after traumatic injury and is associated with more adverse effects (AEs), according to study results presented at the 2025 American Academy of Neurology (AAN) annual meeting, held from April 5 to 9, 2025, in San Diego, California.

There is an unmet clinical need for safe analgesics for the treatment of pain after traumatic injury in the out-of-hospital setting, as morphine is associated with AEs.

Researchers from Jordan University of Science and Technology and the Philadelphia University in Jordan searched publication databases for randomized controlled trials comparing the safety and efficacy of morphine and ketamine as a prehospital analgesia among patients with traumatic pain.

The primary outcome was the change in pain scores and the secondary outcomes were the change in vital signs and complication rates.

A total of 4 trials comprising 757 patients (mean age, 41.96 years; men, 66%) were included in this analysis.

No significant differences in the change in pain scores were observed between prehospital ketamine and morphine administration (mean difference [MD], -0.90; 95% CI, -2.19 to 0.40; P =.17).

Ketamine was associated with a significant increase in systolic blood pressure relative to morphine (MD, 6.27; 95% CI, 2.97-9.57 mmHg; P =.0002), whereas neither heart rate (MD, 0.40; 95% CI, -2.08 to 2.88 beats per minute; P =.75) nor respiratory rate (MD, 0.36; 95% CI, -0.63 to 1.36 breaths per minute; P =.72) were differentially affected by either analgesic.

The incidence of AEs was higher with ketamine (64.5%) than morphine (35.5%).

This study was limited by the overall paucity of data comparing ketamine and morphine as prehospital analgesia after traumatic injury.

“This meta-analysis shows that ketamine is not superior to morphine in terms of prehospital analgesia of traumatic pain and is associated with higher rate of adverse effects. We don’t recommend using ketamine as an alternative to morphine for prehospital analgesia,” the researchers concluded.