2016: Ketamine infusion for chronic non-cancer pain

List:

· Summary

· Rationale for use

· Questions

· Recommendations

· Use is widespread

· Practice varies

· Evidence is lacking

· Induce reversal of central sensitization of nociception

· Facilitate reduction in opioid use with restoration of opioid sensitivity

· Does ketamine do what they say it does?

· Why not just wean the opioid?

· Assessment: social, psychological, biological factors

· Agree on goals: improve pain and QOL, reduce opioid use

· Eligibility criteria: central sensitization + opioid failure/side effects/addiction

· Administration: dedicated line, locked pump, no bolus option

· Monitoring: regular observations, no leaving the ward (and q48h LFTs??)

· Infusion rate: induction 0.05-0.1mg/kg/h, max 0.5mg/kg/h, weaning 12-24 hours, observation 4 hours before discharge

· Side effects: first time – pause 1 hour; second time – medical review

· Follow-up: communicate with GP, plan in case of relapse