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Ketamine Case Study

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Ketamine. Palliative care patients often need a combination of 2-3 opioids to obtain effective analgesia with tolerable side effects (Moryl et al., 2008). Ketamine is considered a front-line treatment for neuropathic pain including cancer pain, central pain, and postherpatic neuralgia phantom pain (Ben-Ari, Lewis, & Davidson, 2007; Fitzgibbon & Viola, 2005). Low-dose ketamine is an effective co-analgesic medication (Fine, 2003; Moryl et al, 2008) and intrathecal ketamine has successfully been used in palliative care (Ben-Ari et al., 2007).
A benefit of ketamine is that is does not affect respirations and can be administered via many routes including: IV, subcutaneous, intranasal, intrathecal, epidural, rectal, and transdermal (Prommer, 2012). However, consider giving other opiates or a benzodiazepine to minimize ketamine’s adverse effects (Soto et al., 2012).
Propofol. Moyle’s (1995) study provided the first case-report of propofol use in palliative care patients. Since then propofol has sporadically been used in palliative care. Low-dose propofol is helpful for decreasing anxiety and opioid requirements (Mercadante, DeConno, & Ripamonti, 1995).
Propofol also has valuable antiemetic properties. In a Swedish study of 35 palliative care patients, 13 …show more content…

Roberts, Wozencraft, Coyne, and Smith (2011) used precedex (0.2 mcg/kg/hr) to control intractable cancer pain in a patient that had failed treatment with high-dose systemic opioids, ketamine, lidocaine, and intrathecal drug delivery. After initiation of precedex the patient’s pain became more tolerable and decreased the need for hydromorphone. The Centro de Suporte Terapêutico Oncológico (Rio de Janerio, Brazil) reported that precedex was a useful adjunct for pain, anxiety, and restlessness in patients with metastatic cancer; however they did not appreciate any opioid-sparing effects (Soares, Naylor, Martins, & Peixoto,

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