• F Marchetti, A Coutaux, A Bellanger, C Magneux, P Bourgeois, and G Mion.
• Unité d'évaluation et de traitement de la douleur, Groupe hospitalier Pitié Salpêtrière, Paris, France.
• Eur J Pain. 2015 Aug 1; 19 (7): 984-93.

BackgroundThis work summarizes the efficiency, failures and adverse effects of oral administration of ketamine at home for intractable pain.MethodsThis 5-year retrospective study involved testing ketamine by intravenous in-hospital administration, then a conversion to an oral route, or oral treatment directly administered at home. The daily intravenous dose was increased by steps of 0.5 mg/kg to attain an effective daily dose of 1.5-3.0 mg/kg. Pain was evaluated on a numeric scale from 0 to 10, and evidence of adverse effects was collected every day. The effective daily dose was delivered orally (three to four intakes). If effective, ketamine was continued for 3 months. Short infusions or direct oral treatment began with a 0.5-mg/kg dose, then the daily ketamine dose was increased in 15- to 20-mg increments.ResultsAmong 55 cases (51 patients, neuropathic pain 60%), the mean effective oral dose was 2 mg/kg. Ketamine was effective in 24 patients (44%, mean pain reduction 67 ± 17%), partially effective in 20% (mean pain reduction 30 ± 11%), with a mean opioid sparing of 63 ± 32%, and failure in 22%. Half of the patients experienced adverse effects, but only eight had to stop treatment. For patients with opioid therapy, failure of ketamine was less frequent (7% vs. 36%; p < 0.02), with fewer adverse effects (33% vs. 68%; p < 0.01).ConclusionsPain was reduced or abolished in two-thirds of patients under ketamine therapy; ketamine was effective for patients taking opioids and resulted in few adverse effects.© 2014 European Pain Federation - EFIC®

This article appears in the collection: Ketamine infusions.

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