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TOTAL REFERENCES RETRIEVED: 179
PHASE OF CARE: End-of-life care
APPLICATIONS: Palliative care
There were five double-blind, randomized, controlled trials, six uncontrolled trials, and one case series in adults. These showed descreases in pain ratings with oral, subcutaneous, sublingual, and IV ketamine. Reduced pain was shown in 50%–90% of participants. Dosages varied greatly across studies. Common side effects were sedation, somnolence, sensory illusions, dissociative feelings, blurred vision, anorexia, abdominal pain, insobriety, and dream disturbances. At higher doses delirium, impaired motor function, amnesia, panic attacks, mania, insomnia, and elevated blood pressure have been reported. Studies in children involved 16 patients treated with IV ketamine.
In adults with chronic pain that is not controlled with opioids, ketamine appears to decrease opioid use and improve pain control. There is insufficient evidence to form any conclusions regarding its use in children.
Few studies, most of which had small samples, particularly among children
Ketamine may be promising for the management of refractory pain that is poorly responsive to opioids; however, its use is associated with a variety of side effects. In most cases for chronic pain, ketamine has been studied in patients with very limited life expectancies. There is very little evidence in children. Further research is needed to fully establish ketamine's usefulness for pain control. If ketamine is used, nurses need to be aware of potential side effects and should monitor patients for them. There is no current evidence to show that ketamine is superior to other therapies for pain.