Sheetal Patil1, Magdalena Anitescu. 1. Department of Anesthesia and Critical Care, University of Chicago Medical Center, 5841 S.Maryland Avenue, Chicago, IL 60637, USA.
Abstract
OBJECTIVE: We evaluated whether outpatient intravenous ketamine infusions were satisfactory for pain relief in patients suffering from various chronic intractable pain syndromes. DESIGN: Retrospective chart review. SETTING AND PATIENTS: Following Institutional Review Board approval, we retrospectively analyzed our database for all ketamine infusions administered over 5 years from 2004 to 2009. OUTCOME MEASURES: Data reviewed included doses of intravenous ketamine, infusion duration, pain scores on visual analog scale (VAS) pre- and post-procedure, long-term pain relief, previous interventions, and side effects. All patients were pretreated with midazolam and ondansetron. RESULTS: We identified 49 patients undergoing 369 outpatient ketamine infusions through retrospective analysis. We excluded 36 infusions because of missing data. Among our patients, 18 (37%) had a diagnosis of complex regional pain syndrome (CRPS). Of the remaining 31 (63%) patients, eight had refractory headaches and seven had severe back pain. All patients reported significant reduction in VAS score of 5.9 (standard error [SE] 0.35). For patients with CRPS, reduction in VAS score was 7.2 (SE 0.51, P < 0.001); for the others, the reduction was 5.1 (SE 0.40, P < 0.001). The difference of 2.1 between groups was statistically significant (SE 0.64, P = 0.002). In 29 patients, we recorded the duration of pain relief. Using the Bernoulli model, we found (90% confidence interval) that the probability of lasting pain relief in patients with refractory pain states was 59-85% (23-51% relief over 3 weeks). CONCLUSIONS: We conclude that in patients with severe refractory pain of multiple etiologies, subanesthetic ketamine infusions may improve VAS scores. In half of our patients, relief lasted for up to 3 weeks with minimal side effects. Wiley Periodicals, Inc.
OBJECTIVE: We evaluated whether outpatient intravenous ketamine infusions were satisfactory for pain relief in patients suffering from various chronic intractable pain syndromes. DESIGN: Retrospective chart review. SETTING AND PATIENTS: Following Institutional Review Board approval, we retrospectively analyzed our database for all ketamine infusions administered over 5 years from 2004 to 2009. OUTCOME MEASURES: Data reviewed included doses of intravenous ketamine, infusion duration, pain scores on visual analog scale (VAS) pre- and post-procedure, long-term pain relief, previous interventions, and side effects. All patients were pretreated with midazolam and ondansetron. RESULTS: We identified 49 patients undergoing 369 outpatientketamine infusions through retrospective analysis. We excluded 36 infusions because of missing data. Among our patients, 18 (37%) had a diagnosis of complex regional pain syndrome (CRPS). Of the remaining 31 (63%) patients, eight had refractory headaches and seven had severe back pain. All patients reported significant reduction in VAS score of 5.9 (standard error [SE] 0.35). For patients with CRPS, reduction in VAS score was 7.2 (SE 0.51, P < 0.001); for the others, the reduction was 5.1 (SE 0.40, P < 0.001). The difference of 2.1 between groups was statistically significant (SE 0.64, P = 0.002). In 29 patients, we recorded the duration of pain relief. Using the Bernoulli model, we found (90% confidence interval) that the probability of lasting pain relief in patients with refractory pain states was 59-85% (23-51% relief over 3 weeks). CONCLUSIONS: We conclude that in patients with severe refractory pain of multiple etiologies, subanesthetic ketamine infusions may improve VAS scores. In half of our patients, relief lasted for up to 3 weeks with minimal side effects. Wiley Periodicals, Inc.
Authors: Kathy A Sheehy; Elena A Muller; Caroline Lippold; Mehdi Nouraie; Julia C Finkel; Zenaide M N Quezado Journal: BMC Pediatr Date: 2015-12-01 Impact factor: 2.125
Authors: Steven P Cohen; Anuj Bhatia; Asokumar Buvanendran; Eric S Schwenk; Ajay D Wasan; Robert W Hurley; Eugene R Viscusi; Samer Narouze; Fred N Davis; Elspeth C Ritchie; Timothy R Lubenow; William M Hooten Journal: Reg Anesth Pain Med Date: 2018-07 Impact factor: 6.288