Role of ketamine for analgesia in adults and children

Abstract

Ketamine an N-methyl-D-aspartate (NMDA) receptor blocking agent and a dissociative anesthetic with neurostimulatory side effects. In recent years, multiple research trials as well as systematic reviews and meta-analyses suggest the usefulness of ketamine as a strong analgesic used in subanesthetic intravenous doses, and also as a sedative. In addition, ketamine was noted to possess properties of anti-tolerance, anti-hyperalgesia and anti-allodynia most likely secondary to inhibition of the NMDA receptors. Tolerance, hyperalgesia and allodynia phenomena are the main components of opioid resistance, and pathological pain is often seen in the clinical conditions involving neuropathic pain, opioid-induced hyperalgesia, and central sensitization with allodynia or hyperalgesia. All these conditions are challenging to treat. In low doses, ketamine does not have major adverse dysphoric effects and also has the favorable effects of reduced incidence of opioid-induced nausea and vomiting. Therefore, ketamine can be a useful adjunct for pain control after surgery. Additional studies are required to determine the role of ketamine in the immediate postoperative period after surgical interventions known to produce severe pain and in the prevention and treatment of chronic pain.

Ketamine Differentially Attenuates Alcohol Intake in Male Versus Female Alcohol Preferring (P) Rats

“…It is abused for its ability to produce dissociative sensations and hallucinations. These effects are invariably associated with relatively high dose of ketamine, which might involve interaction with other neurotransmitter systems including the opioid, cholinergic, dopaminergic, and adenosine receptors as well as inflammatory cytokines [ 15 , 16 , 17 ]. Recently, it has become evident that subanesthetic doses of ketamine can have a rapid and long lasting antidepressant effect in various animal models [ 18 ] as well as in clinical trials.…”

Differences between adolescents and adults in the acute effects of PCP and ketamine and in sensitization following intermittent administration

“…Aside from their recreational use, PCP and ketamine have medical applications that include analgesia and anesthesia (Jouguelet-Lacoste, et al, 2015; Nalini et al, 2016; White and Ryan, 1996). Ketamine produces fewer dissociative effects than PCP and the effects are shorter lived, allowing for broader clinical use.…”

Experimental Gene Therapy with Serine-Histogranin and Endomorphin 1 for the Treatment of Chronic Neuropathic Pain

“…Trujillo and Akil ( 1991 ) provided an initial evidence that NMDA antagonists may inhibit the development of morphine tolerance, thus allow prolonged administration of opioid-based analgesics. Since then, numerous studies confirmed this theory in experimental and clinical setting (Bilsky et al, 1996 ; Mao, 1999 ; Bisaga and Popik, 2000 ; Mendez and Trujillo, 2008 ; Lin et al, 2010 ; Vadivelu et al, 2016 ) and synergistic effects between opioids and NMDA antagonists towards pain relief has been demonstrated in several pain models (Nishiyama, 2000 ; Chow et al, 2004 ; Hama and Sagen, 2014 ). This approach has proven to be effective for combination of low-dose ketamine with opioids such as morphine, that showed more effective analgesic effect for pre or postoperative pain with minimal or no side effects.…”