Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Chronic Pain Management
Over the past two decades, the use of IV ketamine infusions as a treatment for chronic pain has increased dramatically, with wide variation in patient selection, dosing, and monitoring. This has led to a chorus of calls from various sources for the development of consensus guidelines.
The American Society of Regional Anesthesia and Pain Medicine and the American Academy of Pain Medicine initiated this project in 2017. A panel of experts convened to develop and refine questions leading to development of guidelines addressing indications; contraindications; whether there was evidence for a dose-response relationship, or a minimum or therapeutic dose range; whether oral ketamine or another N-methyl-D-aspartate receptor antagonist was a reasonable treatment option as a follow-up to infusions; preinfusion testing requirements; settings and personnel necessary to administer and monitor treatment; the use of preemptive and rescue medications to address adverse effects; and what constitutes a positive treatment response.
The group was able to reach consensus on all questions. Evidence supports the use of ketamine for chronic pain, but the level of evidence varies by condition and dose range.
These guidelines were published July 1, 2018, and will be reviewed again in 2023.