Reply to Letter: Ketamine infusion for pain control in adult patients with multiple rib fractures

摘要

To whom it may concern, The authors of this article would like to thank you and the Journal of Trauma and Acute Care Surgery for the opportunity to draft a response to the commentary provided regarding our article (Table 1). Please see the below response as well as the attached revised Tables 2 and 3 which now reflect the use of median but with no change in the statistical significance of the data. In their letter, Drs. Hou, Xue, Shao, and Wan raised several concerns regarding our article on the use of low-dose ketamine in adult patients with rib fractures. We will address each point directly. We did not dictate the exact treatment regimen that the trauma patients could receive (Table 4). We do utilize a multi-modal pain treatment guideline for our rib fracture patients, which is consistent with the recommended guidelines of the Eastern Association of Trauma. Ninety-eight percent of patients received scheduled acetaminophen, 25% received "as needed" muscle-relaxers, and 32% were given scheduled nonsteroidal anti-inflammatory drugs. While we certainly could improve the compliance with our guideline not every patient is a candidate for nonsteroidal anti-inflammatory drugs or muscle relax-ants. Ultimately, we left these decisions to the treating team and, as shown in the article, there were no differences between groups in the utilization of non-narcotic medications prescribed during the study. For this reason, we doubt that our findings were related to difference in prescribing patterns.