{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T08:19:12Z","timestamp":1783066752114,"version":"3.54.6"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T00:00:00Z","timestamp":1768867200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Israeli Defense Force"},{"name":"Medical Corps Research","award":["# 4440938679"],"award-info":[{"award-number":["# 4440938679"]}]},{"name":"Tel Aviv Medical Center"},{"name":"Research Fund"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Evidence on intranasal (IN) ketamine as an alternative to opioids for acute pain is limited. We compared the efficacy and safety of IN ketamine to intravenous (IV) morphine in emergency department (ED) patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This triple-blinded, placebo-controlled, randomized trial included consenting adult patients with moderate-to-severe pain (\u226570\u2009mm on a visual analog scale [VAS]) who were given either 0.1\u2009mg\/kg IV morphine and IN placebo or 1\u2009mg\/kg IN ketamine and IV placebo and were monitored for vital signs, pain levels, and adverse events (AEs) for 120\u2009minutes. The primary outcome was the efficacy of IN ketamine compared with IV morphine in reducing pain, defined as achieving a\u2009\u2265\u200915-mm decrease in the VAS pain score. The secondary outcomes were AEs and overall patient satisfaction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sixty-eight participants (mean age 43.5\u2009\u00b1\u200912.2\u2009years, 48 male) were randomized equally. Groups were similar at baseline in mean age, sex, and pre-treatment median pain levels. There were no significant differences between IV morphine and IN ketamine groups in the median [intraquartile range (IQR)] values of time to onset of significant pain reduction (10.0 [5.0-20.0] vs. 10.0 [5.0-15.0] minutes, P\u2009=\u2009.92), maximal pain reduction (30.0 [10.0-57.0] vs. 20.5 [4.2-39.5] mm VAS, P\u2009=\u2009.18) and time to maximal pain reduction (105.0 [63.7\u2014120.0] vs. 90.0 [45.0-120.0] minutes, P\u2009=\u2009.35). There were no significant differences in frequency of adverse effects at 0, 60, and 120\u2009minutes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study did not demonstrate a statistically significant difference in efficacy or safety between IN ketamine and IV morphine for the management of acute pain in the ED. Moreover, the findings indicate that IN ketamine may be a viable, and potentially superior, alternative to IV morphine.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/pm\/pnag012","type":"journal-article","created":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T12:34:33Z","timestamp":1768653273000},"page":"719-726","source":"Crossref","is-referenced-by-count":0,"title":["Intra-nasal ketamine compared to intravenous morphine for acute pain in the emergency department: a prospective, triple blind, controlled study"],"prefix":"10.1093","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4143-5302","authenticated-orcid":false,"given":"Noaa","family":"Shopen","sequence":"first","affiliation":[{"name":"Emergency Department, Tel Aviv Sourasky Medical Center, Tel Aviv ,","place":["Israel"]},{"name":"Gray Faculty of Medicine and Health Science, Tel Aviv University , Tel Aviv,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7694-6407","authenticated-orcid":false,"given":"Neta","family":"Cohen","sequence":"additional","affiliation":[{"name":"Pediatric Emergency Department, Dana Dwek Children\u2019s Hospital, Tel Aviv Sourasky Medical Center , Tel Aviv,","place":["Israel"]},{"name":"Gray Faculty of Medicine and Health Science, Tel Aviv University , Tel Aviv,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michal","family":"Mizrahi","sequence":"additional","affiliation":[{"name":"Emergency Department, Tel Aviv Sourasky Medical Center, Tel Aviv ,","place":["Israel"]},{"name":"Gray Faculty of Medicine and Health Science, Tel Aviv University , Tel Aviv,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reut","family":"Aviv Mordechai","sequence":"additional","affiliation":[{"name":"Emergency Department, Tel Aviv Sourasky Medical Center, Tel Aviv ,","place":["Israel"]},{"name":"Gray Faculty of Medicine and Health Science, Tel Aviv University , Tel Aviv,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omri","family":"Ritter","sequence":"additional","affiliation":[{"name":"Emergency Department, Tel Aviv Sourasky Medical Center, Tel Aviv ,","place":["Israel"]},{"name":"Pain Clinic, Tel Aviv Sourasky Medical Center , Tel Aviv,","place":["Israel"]},{"name":"Gray Faculty of Medicine and Health Science, Tel Aviv University , Tel Aviv,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julieta","family":"Werthein","sequence":"additional","affiliation":[{"name":"Emergency Department, Tel Aviv Sourasky Medical Center, Tel Aviv ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren Achiam","family":"Cohen","sequence":"additional","affiliation":[{"name":"Emergency Department, Tel Aviv Sourasky Medical Center, Tel Aviv ,","place":["Israel"]},{"name":"Gray Faculty of Medicine and Health Science, Tel Aviv University , Tel Aviv,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Zeltser","sequence":"additional","affiliation":[{"name":"Emergency Department, Tel Aviv Sourasky Medical Center, Tel Aviv ,","place":["Israel"]},{"name":"Gray Faculty of Medicine and Health Science, Tel Aviv University , Tel Aviv,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pinchas","family":"Halpern","sequence":"additional","affiliation":[{"name":"Gray Faculty of Medicine and Health Science, Tel Aviv University , Tel Aviv,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,1,20]]},"reference":[{"key":"2026070303521626100_pnag012-B1","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.ajem.2023.11.056","article-title":"Low-dose ketamine versus morphine in the treatment of acute pain in the emergency department: A meta-analysis of 15 randomized controlled trials","volume":"76","author":"Guo","year":"2024","journal-title":"Am J Emerg Med"},{"key":"2026070303521626100_pnag012-B2","doi-asserted-by":"publisher","first-page":"1141","DOI":"10.1007\/s11739-020-02411-2","article-title":"Approaching acute pain in emergency settings; European Society for Emergency Medicine (EUSEM) guidelines-part 2: management and recommendations","volume":"15","author":"Hachimi-Idrissi","year":"2020","journal-title":"Intern Emerg Med"},{"key":"2026070303521626100_pnag012-B3","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.annemergmed.2017.06.043","article-title":"Policy Statement. 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