FOCUS ON PHARMACOLOGY
PEER REVIEWED
KETAMINE: To Use or Not to Use for Pain Management
Mark E. Epstein, DVM, Diplomate ABVP (C/F), CVPP, & dAAPM K
etamine has been in long and routine use as a dissociative anesthetic. More recently, new phar- macologic features of ketamine have been dis- covered that provide novel pain modification.
IT’S PLACE IN PAIN MANAGEMENT It is well-established in human medicine that the use of adjunct medications, including ketamine, minimiz- es the use of PCA (patient-controlled analgesia) opi- oids, with a resulting decrease in incidence of adverse effects, such as postoperative nausea and constipation, which in turn, quickens discharge from the hospital.1 However, ketamine is not considered an analgesic
drug. Rather, it appears to be protective against hyper- algesia and central hypersensitization in the postopera- tive setting.2
These effects can be important in reduc-
ing immediate postoperative morbidity and persistent postoperative pain. In humans, acute postoperative pain is followed
by persistent pain in 10% to 50% of individuals after common operations, such as groin hernia repair, breast and thoracic surgery, and amputations. Chronic pain is severe in about 2% to 10% of these patients.3 While we do not have this kind of epidemiologic data
in animals, there is little reason to doubt that they can experience severe or protracted pain.
July/August 2011 Today’s Veterinary Practice
47