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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Reg+Anesth+Pain+Med
2018 ; 43
(5
): 456-466
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Acute Pain
Management From the American Society of Regional Anesthesia and Pain Medicine,
the American Academy of Pain Medicine, and the American Society of
Anesthesiologists
#MMPMID29870457
Schwenk ES
; Viscusi ER
; Buvanendran A
; Hurley RW
; Wasan AD
; Narouze S
; Bhatia A
; Davis FN
; Hooten WM
; Cohen SP
Reg Anesth Pain Med
2018[Jul]; 43
(5
): 456-466
PMID29870457
show ga
BACKGROUND: Ketamine infusions have been used for decades to treat acute pain,
but a recent surge in usage has made the infusions a mainstay of treatment in
emergency departments, in the perioperative period in individuals with refractory
pain, and in opioid-tolerant patients. The widespread variability in patient
selection, treatment parameters, and monitoring indicates a need for the creation
of consensus guidelines. METHODS: The development of acute pain ketamine
guidelines grew as a corollary from the genesis of chronic pain ketamine
guidelines. The charge for the development of acute pain ketamine guidelines was
provided by the Boards of Directors of both the American Society of Regional
Anesthesia and Pain Medicine and the American Academy of Pain Medicine, who
approved the document along with the American Society of Anesthesiologists'
Committees on Pain Medicine and Standards and Practice Parameters. The committee
chair developed questions based on input from the committee during conference
calls, which the committee then refined. Groups of 3 to 5 panel members and the
committee chair were responsible for answering individual questions. After
preliminary consensus was achieved, the entire committee made further revisions
via e-mail and conference calls. RESULTS: Consensus guidelines were prepared in
the following areas: indications, contraindications for acute pain and whether
they differ from those for chronic pain, the evidence for the use of ketamine as
an adjunct to opioid-based therapy, the evidence supporting patient-controlled
ketamine analgesia, the use of nonparenteral forms of ketamine, and the
subanesthetic dosage range and whether the evidence supports those dosages for
acute pain. The group was able to reach consensus on the answers to all
questions. CONCLUSIONS: Evidence supports the use of ketamine for acute pain in a
variety of contexts, including as a stand-alone treatment, as an adjunct to
opioids, and, to a lesser extent, as an intranasal formulation. Contraindications
for acute pain are similar to those for chronic pain, partly based on the
observation that the dosage ranges are similar. Larger studies evaluating
different acute pain conditions are needed to enhance patient selection,
determine the effectiveness of nonparenteral ketamine alternatives, define
optimal treatment parameters, and develop protocols optimizing safety and access
to care.