Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 2 3 2018 04 03 e30 e30 Ali Mohammadshahi Department of Emergency Medicine, AJA University of Medical Sciences, Tehran, Iran. Ali Abdolrazaghnejad Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Hamed Nikzamir Department of Emergency Medicine, AJA University of Medical Sciences, Tehran, Iran. Arash Safaie Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2018 04 03 Introduction: pain management is an important and challenging issue in emergency medicine. Despite the conduct of several studies on this topic, pain is still handled improperly in many cases. Objective: This study investigated the effectiveness of low-dose IN ketamine administration in reducing the need for opiates in patients in acute pain resulting from limb injury. Method: This randomized, double-blind, placebo-controlled trial was conducted to assess the possible effect of low-dose intranasal (IN) ketamine administration in decreasing patients' narcotic need. Patients in emergency department suffering from acute isolated limb trauma were included. One group of patients received 0.5 mg/kg intravenous morphine sulfate and 0.02 ml/kg IN ketamine. The other group received the same dose of morphine sulfate and 0.02 ml/kg IN distilled water. Pain severity was measured using the 11 points numerical rating scale at 0, 10, 30, 60, 120, and 180 minutes. Results: Ninety-one patients with mean age of 31.59 ± 11.33 years were enrolled (38.8% female). The number of requests for supplemental medication was significantly lower in patients who received ketamine (12 patients (30%)) than those who received placebo (27 patients (67.5%)) (p = 0.001). Conclusion: It is likely that low-dose IN ketamine is effective in reducing the narcotic need of patients suffering from acute limb trauma. https://fem.tums.ac.ir/index.php/fem/article/view/75 https://fem.tums.ac.ir/index.php/fem/article/download/75/63