Background Ketamine is used in palliative care to help relieve refractory pain that does not respond to conventional opioids or adjuvant analgesics. It is commonly administered via subcutaneous or the oral route. This however has its limitations since ketamine infusion can cause skin irritation and result in its reduced absorption and intolerable adverse effects We demonstrate our experience in the use of intravenous (IV) bolus doses of ketamine to help control acute pain as well as to help assess adverse effects which can predict the appropriateness of commencing a subsequent infusion of ketamine.
Aim Prospective review of patients receiving IV bolus ketamine in a tertiary cancer hospital from August 2010 to September 2011.
Method Administration of Slow IV bolus doses of ketamine. Titration of ketamine depending on improvement in pain relief or advent of intolerable adverse effects. Assessment of extent of pain relief following administration of ketamine. Patients were asked to rate pain from 0 (no pain) to 10 (worst pain) The pain scores were taken prior to and during and post administration of ketamine.
Results Eleven patients received IVbolus doses of Ketamine during this period.All patients received haloperidol 1.5 mg s/c prior to IV ketamine. The average age of patients 47 Mean pain score prior to initiation of ketamine 8/10 Background opioids in morphine equivalent doses (MEQ)ï¿½Mean MEQ=330 mg average dose of ketamine administered=20 mg(range7.4–40 mg). Average pain score post administration=2/10 adverse effects: drowsiness 63%, intoxicated feeling 18% severe visual hallucination 9%. One patient required administration of IV midazolam to counter the adverse effects. Nine out of 11 patients conitnued with either s/c or IV infusions of ketamine.
Conclusion Administration of IV ketamine is an effective and safe method in managing acute pain in palliative care
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