Ketamine Guidelines for Acute Pain Management Established and Released for the First Time

Friday, June 15, 2018

Intravenous (IV) ketamine has been used to treat acute pain in multiple conditions including as a stand-alone treatment, and as an adjunct to opioids. Ketamine is being used in both inpatient and outpatient settings to manage acute and chronic pain. Awareness of this treatment has increased recently as a result of the effort to reduce the risks of long-term opioid use, and ultimately addiction.

New guidelines have been established and approved by the American Society of Regional Anesthesia and Pain Medicine and the American Academy of Pain Medicine, both of which spearheaded the guideline development. Additionally, the American Society of Anesthesiologists’ Committees on Pain Medicine and Standards and Practice Parameters has also approved the document.

“The goal of this document is to provide a framework for doctors, for institutions and for payers on use of ketamine for acute pain, who should get it and who should not get it,” stated guideline author Steven Cohen, MD, John Hopkins School of Medicine, Baltimore, Maryland.

Dosing guidelines recommend that ketamine bolus doses remain at or under 0.35 mg/kg, and in settings without intensive monitoring, ketamine infusions for acute pain should not exceed 1 mg/kg per hour. Dosing outside of these ranges may be needed for individuals with prior ketamine exposure and other factors. The authors of the guidelines acknowledge these adjustments.

The guidelines also acknowledge that some evidence supports use of subanesthetic IV ketamine bolus doses and infusions as adjuncts to opioids for perioperative analgesia.

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