Presented at the 2012 AAPM Annual Meeting « Back

Hemodynamic and Side-Effect Profile of Multi-Day Outpatient Ketamine Infusion for Neuropathic Pain

Elvis W. Rema, MD, elvisrema@aol.com¹, May L. Chin, MD², Mourad Shehebar, MD³, (1) New York Presbytarian, New York, New York, (2) George Washington University, Washington, District of Columbia, (3) George Washington University School of Medicine and Health Sciences, Washington, District Of Columbia

Introduction: Ketamine infusions have been reported to be useful in reducing neuropathic pain not responsive to other treatment modalities. However there are concerns with potential side effects such as hallucinations, cognitive disturbances, nausea, vomiting, and hemodynamic instability. This retrospective chart review was initiated to study the safety and efficacy of outpatient multi-day low-dose ketamine infusions in patients with chronic neuropathic pain. Methods: After IRB approval a chart review was initiated to include all patients undergoing multiple consecutive days of outpatient ketamine infusion for neuropathic pain from July 2009 to August 2010. We reviewed 34 subjects: 12 males and 22 females. The ketamine dose was increased incrementally each day from 0.2 to 0.4 and 0.6 mg/kg/hr for four hours. We measured pre- and post-infusion NRS; pre-, intra-, and post-infusion blood pressure, heart rate, and the incidence of nausea. Results: There was no significant difference between three doses for systolic and diastolic blood pressures, heart rate, and incidence of nausea. There was no difference in the change of NRS between the 0.2 and 0.4 groups. There was a significant decrease in NRS between the 0.2 and 0.6 doses (p = 0.029). Conclusion: The results demonstrated minimal side effects and stable hemodynamics. Ketamine may therefore offer a safe alternative treatment for recalcitrant neuropathic pain in an outpatient setting. References: 1)T.S. Jensen, H. Gottrup, S.H. Sindrup and F.W. Bach, The clinical picture of neuropathic pain. Eur J pharmacol 429 (2001), pp. 1–11. 2)Schwartzman RJ, Goldberg ME, Dotson J, et al. Multi-day low dose ketamine infusion for the treatment of complex regional pain syndrome (CRPS). A15. Neurology. 2004;62(suppl 5). 3)Webster LR, Walker MJ. Safety and effectiveness of prolonged outpatient ketamine infusions for neuropathic pain. Presented at the 6th International Conference on Mechanisms and Treatment of Neuropathic Pain, San Francisco, 2003.

Funding: None