Abstract
Objective
Low-dose ketamine (LDK) may be useful for treatment for opioid-tolerant patients.
We conducted a survey of patients and their treating clinicians regarding LDK for
analgesia.
Methods
Survey data included the following: vital signs and pain score before and after LDK,
demographics, and adverse effects. Treating physicians were queried about reasons
for use of LDK and overall satisfaction.
Results
Twenty-four patients were enrolled: 21 received LDK for analgesia, and 3 received
LDK for sedation. Pain level on a visual analog scale (range, 1-10) after LDK was
significantly decreased from 8.9 ± 2.1 to 3.9 ± 3.4 (P < .0001). Change in vital signs after administration of LDK was not statistically
significant. Overall patient satisfaction with LDK was 55%, and overall physician
satisfaction was 72%. Sixteen (67%) of patients would prefer LDK again, and 23 (96%)
of physicians would use LDK again for analgesia. Four patients reported an adverse
experience, but there were no emergence reactions. Race subanalysis revealed no difference
in pain reduction, but whites were least satisfied compared with black and Hispanic
patients (P = .02). Physician reasons for using LDK included opioid failure (88%), concern for
respiratory depression (17%), concern for multiple opioid allergies (13%), and concern
for hypotension (8%). Most (96%) physicians believed that LDK is underused.
Conclusion
Low-dose ketamine may decrease patients' perception of pain. Most were satisfied with
LDK for this purpose and would use it again. Whites were least satisfied with the
use of LDK for analgesia. Physicians believed that ketamine is underused.
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References
- Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update.Ann Emerg Med. 2011; 57: 449-461
- Ketamine for acute and subacute pain in opioid-tolerant patients.J Opioid Manag. 2008; 4: 173-180
- Development of opioid tolerance—molecular mechanisms and clinical consequences.Anasthesiol Intensivmed Notfallmed Schmerzther. 2003; 38: 14-26
- Is there genetic polymorphism evidence for individual human sensitivity to opiates?.Curr Pain Headache Rep. 2007; 11: 115-123
- Pharmacogenetics of opioids.Clin Pharmacol Ther. 2007; 81: 429-444
- Opioid-induced hyperalgesia.J Perianesth Nurs. 2012; 27: 46-50
- Inhibition of morphine metabolism by ketamine.Drug Metab Dispos. 2010; 38: 728-731
- The anti-inflammatory effects of ketamine: state of the art.Acta Anaesthesiol Belg. 2011; 62: 47-58
- Subanesthetic ketamine infusion therapy: a retrospective analysis of a novel therapeutic approach to complex regional pain syndrome.Pain Med. 2004; 5: 263-275
- Ketamine for the treatment of chronic non-cancer pain.Expert Opin Pharmacother. 2010; 11: 2417-2429
- Low-dose ketamine with multimodal postcesarean delivery analgesia: a randomized controlled trial.Int J Obstet Anesth. 2011; 20: 3-9
- A systematic review of intravenous ketamine for postoperative analgesia.Can J Anaesth. 2011; 58: 911-923
- Repeated and escalating preoperative subanesthetic doses of ketamine for postoperative pain control in patients undergoing tumor resection: a randomized, placebo-controlled, double-blind trial.Clin Ther. 2011; 33: 863-873
- Postoperative ketamine administration decreases morphine consumption in major abdominal surgery: a prospective, randomized, double-blind, controlled study.Anesth Analg. 2008; 106: 1856-1861
- Pre-incisional analgesia with intravenous or subcutaneous infiltration of ketamine reduces postoperative pain in patients after open cholecystectomy: a randomized, double-blind, placebo-controlled study.Pain Med. 2011; 12: 1418-1426
- Preemptive use of ketamine on post operative pain of appendectomy.Korean J Pain. 2011; 24: 137-140
- Analgesia and sedation in the intensive care of burn patients: results of a European survey.J Intensive Care Med. 2011; 26: 397-407
- Effects of midazolam/low-dose ketamine conscious intravenous sedation on pain, swelling, and trismus after surgical extraction of third molars.J Oral Maxillofac Surg. 2011; 69: 1023-1030
- Preemptive low-dose epidural ketamine for preventing chronic postthoracotomy pain: a prospective, double-blinded, randomized, clinical trial.Clin J Pain. 2011; 27: 304-308
- Low-dose ketamine for analgesia in the ED: a retrospective case series.Am J Emerg Med. 2010; 28: 820-827
- Ketamine in adult emergency medicine: controversies and recent advances.Ann Pharmacother. 2011; 45: 1525-1534
- The effect of combined treatment with morphine sulphate and low-dose ketamine in a prehospital setting.Scand J Trauma Resusc Emerg Med. 2009; 17: 61
- Psychedelic effects of subanesthetic doses of ketamine.Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2009; 31: 68-72
- Ketamine in the ED: medical politics versus patient care.Am J Emerg Med. 1999; 17: 722-725
- ‘The drug of war’—a historical review of the use of ketamine in military conflicts.J R Nav Med Serv. 2009; 95: 145-150
- Ketamine as an analgesic in the pre-hospital setting: a systematic review.Acta Anaesthesiol Scand. 2011; 55: 638-643
- A preliminary naturalistic study of low-dose ketamine for depression and suicide ideation in the emergency department.Int J Neuropsychopharmacol. 2011; 14: 1127-1131
Article Info
Publication History
Published online: October 08, 2012
Accepted:
July 27,
2012
Received in revised form:
July 21,
2012
Received:
June 15,
2012
Footnotes
☆Presented at the Society for Academic Emergency Medicine Western Regional Meeting, Las Vegas, Nevada, March 16, 2012.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
