2016: Ketamine infusion for chronic non-cancer pain

 

List:

·         Summary

·         Rationale for use

·         Questions

·         Recommendations

 

Summary:

·         Use is widespread

·         Practice varies

·         Evidence is lacking

 

Rationale for use:

·         Induce reversal of central sensitization of nociception

·         Facilitate reduction in opioid use with restoration of opioid sensitivity

 

Questions:

·         Does ketamine do what they say it does?

·         Why not just wean the opioid?

 

Recommendations:

·         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

 

Feedback welcome at ketaminenightmares@gmail.com