Effects of Low‐Dose IV Ketamine on Peripheral and Central Pain from Major Limb Injuries Sustained in Combat. Issue 7 (16th April 2013)

• Record Type: Journal Article
• Authors: Polomano, Rosemary C.; Buckenmaier, Chester C.; Kwon, Kyung H.; Hanlon, Alexandra L.; Rupprecht, Christine; Goldberg, Cynthia; Gallagher, Rollin M.
• Is Part Of: Pain medicine. Volume 14:Issue 7(2013)
• Page Start: 1088
• Page End: 1100
• Publication Date: 2013-04-16
• Subjects: Pain -- Periodicals; Pain -- Treatment -- Periodicals; Analgesics -- Periodicals; Pain -- Periodicals; Pain Management -- Periodicals; Douleur -- Périodiques; Douleur -- Traitement -- Périodiques; Analgésiques -- Périodiques; Analgésique; Soulagement de la douleur; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.047205
• DOI: 10.1111/pme.12094
• Languages: English
• ISSNs: 1526-2375

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="pme12094-sec-0001" sec-type="section"> <title>Objective.</title> <p>Examine response patterns to low‐dose intravenous (IV) ketamine continuous infusions on multiple pain outcomes, and demonstrate effectiveness, safety, and tolerability of ketamine administration on general wards.</p> </sec> <sec id="pme12094-sec-0002" sec-type="section"> <title>Design.</title> <p>Retrospective case series of consecutive patients given low‐dose IV ketamine continuous infusions.</p> </sec> <sec id="pme12094-sec-0003" sec-type="section"> <title>Setting.</title> <p>Walter Reed Army Medical Center, Washington, DC.</p> </sec> <sec id="pme12094-sec-0004" sec-type="section"> <title>Patients.</title> <p>Nineteen eligible inpatients with neuropathic pain from major limb injuries sustained in combat with inadequate pain control from multimodal analgesia.</p> </sec> <sec id="pme12094-sec-0005" sec-type="section"> <title>Interventions.</title> <p>A 3‐day IV infusion of ketamine at doses ≤120 μg/kg/h.</p> </sec> <sec id="pme12094-sec-0006" sec-type="section"> <title>Outcome Measures.</title> <p>Daily present (PPI), average (API), and worst (WPI) pain intensity (0–10), global pain relief (GPR) (1 "no relief" to 5 "complete relief"), daily assessments of adverse events, and daily opioid requirements measured during therapy.</p> </sec> <sec id="pme12094-sec-0007" sec-type="section"> <title>Results.</title> <p>A significant reduction in PPI (<italic>P</italic> < 0.001) and improvement in GPR (<italic>P</italic> = 0.031) was noted over time. Higher baseline WPI (≥7; N = 14) was associated with a significant decrease in WPI (<italic>P</italic> = 0.0388), but lower baseline WPI (N = 5) was not. Significant mean percent decreases in PPI with higher baseline PPI (N = 8; <italic>P</italic> = 0.0078) and WPI with no phantom limb pain (PLP) (N = 10; <italic>P</italic> = 0.0436) were observed. Mean percent increase in overall GPR was better for those reporting GPR scores ≤3 (N = 13) in the first 24 hours of therapy (<italic>P</italic> = 0.0153). While not significant, mean opioid requirement (IV morphine equivalents) decreased from 129.9 mgs ± 137.3 on day 1 to 112.14 ± 86.3 24 hours after therapy.</p> </sec> <sec id="pme12094-sec-0008" sec-type="section"> <title>Conclusions.</title> <p>Low‐dose ketamine infusions for complex combat injury pain were safe and effective, and demonstrated response patterns over time and by baseline pain score stratification and presence or absence of PLP.</p> </sec> </abstract>