The ketamine lozenge showed acceptable storage stability. Bioavailability was sufficiently high and reproducible to support its use in routine pain management. There was extensive first-pass conversion to norketamine. Efficacy studies are warranted to evaluate sublingual and oral administration of our new lozenge formulation of ketamine in patients with chronic pain states. Investigation of the role of the metabolite norketamine, which is also an NMDA receptor antagonist, is particularly important because this may contribute significantly to clinical efficacy.

Multimodal analgesia and local anaesthetic techniques are the avenues to improve the still disappointing quality of analgesia after ambulatory surgery.

No abstract