Ketamine for pain management

Abstract

Supplemental Digital Content is Available in the Text.

NMDA receptor antagonists and pain relief

“…Clinical data are consistent with analgesic benefits of NMDAR antagonists for neuropathic pain 1 , CRPS 1,8 , acute pain in the emergency room 15 , and a reduced requirement for opiods 4 .…”

“…across time points or different dosages), all such data were extracted. The following data decisions were also made: (1) for intravenous ketamine studies, only pain outcome data collected during the infusion period were extracted, due to ketamine's rapid elimination from the bloodstream 24 ; (2) When M/SDs were not reported, effect sizes were calculated from any other data that allowed their computation 7 ; (3) for a few studies reporting use of multiple outcomes but only providing data for some outcomes, data were extracted for available outcomes, and; (4) while NMDA dosage in mg/kg bodyweight was extractable for most studies, (i) 16 studies reported total dose only, and (ii) 1 study reported blood plasma. For (i), mg/kg was calculated using mean body weight imputed from study sex composition and country 35 , and for (ii) we used published equivalency data for blood plasma 2,34 .…”

Low Dose Ketamine Used for Acute Pain Management in the Emergency Department

“…Ketamine at a low dose, has been used as a pharmacological intervention for pain relief in the emergency department during procedural sedation for many years [17]. Low dose ketamine in the emergency department may be especially useful as an intervention for patients with refractory pain due to high tolerance levels to opioid analgesics that may also have multifactorial components such as neuropathic pain, depression and inflammatory processes [7].…”

“…If low dose ketamine is used in the emergency department as a pharmacological treatment for pain, it is important to take into consideration the risks and benefits, least effective and most effective uses. Low dose ketamine is an effective pharmacological treatment of pain by itself and as an adjunct to opioids [7] [30] because it is a non-competitive NMDA antagonist and it does not interfere with receptors used by opioids [7] [19] [30]. As an adjunct therapy, it is especially important to consider the dosing of opioids in order to prevent opioid-ketamine adverse reactions.…”

“…As an unintended consequence, the amount of lives lost constitutes a public health crisis. A review of literature identifies the evidence of the efficacy and safety of using low dose ketamine as an alternative to opioid analgesics [6] [7] [8] [9].…”