Residents and Fellows Research in Progress
Monday, November 13, 2023
01:00 PM–02:30 PM
Abstract
Introduction: Ketamine’s use in pain management has been rapidly evolving. Studies have evaluated its use in chronic refractory pain, neuropathic pain, post-operative pain, and opioid-resistant cancer pain. While several studies demonstrate a benefit, the majority of these patients are given ketamine through intravenous (IV) or intramuscular (IM) routes. To allow for ease of administration, limit infection risk, and
minimize pain with parenteral administration,
allow patient autonomy, use of a more novel approach with oral ketamine is important to study in this patient population.
Research Question or Hypothesis: Would patients with complex pain regimens benefit from the addition of oral ketamine to their treatment regimen?
Study Design: A retrospective observational study conducted at an academic level 1 trauma center between 4/1/2017 – 6/1/23.
Methods: The primary outcome was reduction in use of opioids calculated as oral morphine equivalents (OME) on days 1, 2, 3, 4. Secondary outcomes were reduction in subjective pain and safety. Statistics were demonstrated by descriptive analysis. Patients were included if they were > 18 years of age, consulted on the palliative care service, and used oral ketamine during the admission. Patients who had contraindications to ketamine were excluded.
Results: Seven patients screened, 6 were included for analysis for the primary outcome. Half of the patients had a reduction in OME’s. Four of those patients had IV ketamine prior to transitioning to oral. For the secondary outcome of subjective reduction in pain, six patients reported reduction. Ketamine was safe and generally well tolerated with one episode of nausea, and two episodes of psychiatric disturbances.
Conclusion: Half of the patients included in the analysis had a reduction of OME’s. Six patients had subjective decrease in pain. While the small patient population prevents generalizable conclusions, this study prompts for more prospective studies to be conducted on a novel route of ketamine for complex pain.
Presenting Author
Wyatt Starman Pharm.D.Scripps Mercy Hospital
Authors
Harminder Sikand Pharm.D., FCSHP, FASHP, FCCP
Scripps Mercy Hospital
Daryush Tabatabai Pharm.D., BCPS, AAHIVP
Scripps Mercy Hospital