Background: To assess the response to ketamine in patients with difficult pain syndromes. Methods: The charts of patients with uncontrolled pain despite opioid dose escalation of at least two opioids or a combination of them, selected for a burst of ketamine and midazolam were reviewed. One hundred mg/day of ketamine and midazolam 15 mg/day by a continuous intravenous infusion for about 48 hours was offered to patients. Results: Forty-four patients received a burst of ketamine. Ten patients did not achieve any improvement. Pain intensity decreased from a mean of 7.8 (SD, 1.6) to 2.8 (SD, 1.3) (P<0.0005). The outcome was considered optimal, good, and mild in 24, 9, and 1 patients, respectively. Adverse effects attributable to ketamine did not have relevant intensity and no patient discontinued the treatment due to psychomimetic adverse effects. Conclusions: This data suggests that a burst of ketamine and midazolam at low doses, may reverse an unfavourable opioid response, assisting the opioid switching. Although the role of ketamine remains controversial, it should not deter physicians to do not use that in specific conditions.

Mercadante, S., Caruselli, A., Casuccio, A. (2018). The use of ketamine in a palliative-supportive care unit: A retrospective analysis. ANNALS OF PALLIATIVE MEDICINE, 7(2), 205-210 [10.21037/apm.2018.01.01].

The use of ketamine in a palliative-supportive care unit: A retrospective analysis

Casuccio, Alessandra
2018-01-01

Abstract

Background: To assess the response to ketamine in patients with difficult pain syndromes. Methods: The charts of patients with uncontrolled pain despite opioid dose escalation of at least two opioids or a combination of them, selected for a burst of ketamine and midazolam were reviewed. One hundred mg/day of ketamine and midazolam 15 mg/day by a continuous intravenous infusion for about 48 hours was offered to patients. Results: Forty-four patients received a burst of ketamine. Ten patients did not achieve any improvement. Pain intensity decreased from a mean of 7.8 (SD, 1.6) to 2.8 (SD, 1.3) (P<0.0005). The outcome was considered optimal, good, and mild in 24, 9, and 1 patients, respectively. Adverse effects attributable to ketamine did not have relevant intensity and no patient discontinued the treatment due to psychomimetic adverse effects. Conclusions: This data suggests that a burst of ketamine and midazolam at low doses, may reverse an unfavourable opioid response, assisting the opioid switching. Although the role of ketamine remains controversial, it should not deter physicians to do not use that in specific conditions.
http://apm.amegroups.com/article/download/19073/19103
Mercadante, S., Caruselli, A., Casuccio, A. (2018). The use of ketamine in a palliative-supportive care unit: A retrospective analysis. ANNALS OF PALLIATIVE MEDICINE, 7(2), 205-210 [10.21037/apm.2018.01.01].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10447/292180
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