Ketamine infusion therapy for chronic pain management in South Korea A national survey for pain physicians with a narrative review

Anyela Marcela Castañeda Anaya, Jae Kyu Choi, Chang Soon Lee, Euna Oh, Youngwon Kim, Jeeyoun Moon, Pyung Bok Lee, Yong Chul Kim

Research output: Contribution to journalReview article

2 Scopus citations

Abstract

Although ketamine infusion therapy (KIT) has been used extensively for the treatment of chronic persistent pain, there remains high heterogeneity in the administration protocols. The aim of this study was to assess the current clinical use and the infusion protocols of KIT in South Korea and to compare the protocol details with previous relevant studies. In the first phase, an online survey about KIT, including protocol information, was distributed to pain physicians managing chronic pain patients at 47 teaching hospitals registered in the Korean Pain Society. In the second phase, a review of the KIT protocols in previous clinical studies was conducted and compared with the survey results. Among 47 institutions, 35 replied; among them, 25 institutions performed KIT on an outpatient basis. The administration protocol for KIT varied greatly among institutions: the total infusion dose of ketamine ranged from 3.5 to 140 mg/70 kg, with a mode of 70 mg [interquartile range (IQR): 62.0; 8.0–70.0 mg] administered in 1 to 3 hours. In 10 previous studies of outpatient KIT, the total dose of ketamine ranged from 12.6 to 98 mg/70 kg, with a mode of 35 mg [IQR: 40 mg; 23–63 mg] given in 1 to 4 hours, which was significantly lower than in our results (P = .01). In the survey, physicians listed hallucination as the most frequent side effect. Although KIT is used in Korean pain centers, there is wide variation regarding the specific infusion protocols. The total dose of ketamine used in South Korea is significantly higher than the general recommendations for outpatient management and may compromise patient safety. The results of this survey reinforce the need for specific guidelines for KIT in managing chronic pain that counterbalance its risks and benefits. Abbreviations: CRPS = complex regional pain syndrome, IQR = interquartile range, KIT = ketamine infusion therapy, LD = loading dose, MD = maintenance dose, NMDAR = N-methyl-D-aspartate receptor, PHN = postherpetic neuralgia, RCT = randomized controlled trials, SRQR = Standards for Reporting Qualitative Research.

Original languageEnglish
Article numbere11709
JournalMedicine (United States)
Volume97
Issue number32
DOIs
StatePublished - 1 Aug 2018

Keywords

  • Chronic pain
  • Ketamine infusion therapy
  • Protocol
  • Survey

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