Bredlau, A.L., Thakur, R., Korones, D.N., & Dworkin, R.H. (2013). Ketamine for pain in adults and children with cancer: A systematic review and synthesis of the literature. Pain Medicine, 14, 1505–1517. 

DOI Link

Purpose

STUDY PURPOSE: To synthesize data on ketamine for refractory cancer pain in adults and children
 
TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: MEDLINE and PubMed
 
KEYWORDS: Ketamine, cancer pain, and related medical subject heading terms 
 
INCLUSION CRITERIA: Peer-reviewed publications, use of ketamine for refractory pain, any research design and case series including more than 10 patients
 
EXCLUSION CRITERIA: Ketamine use for procedural pain

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 179

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 13 (in adults), 5 (in children)
  • TOTAL PATIENTS INCLUDED IN REVIEW: 483 adults
  • SAMPLE RANGE ACROSS STUDIES: 9–181 patients
  • KEY SAMPLE CHARACTERISTICS: All had refractory pain.

Phase of Care and Clinical Applications

PHASE OF CARE: End-of-life care
 
APPLICATIONS: Palliative care

Results

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.

Conclusions

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.

Limitations

Few studies, most of which had small samples, particularly among children

Nursing Implications

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.

Legacy ID

4827