Ketamine drips post op for chronic pain pts

[kanzi monkey]

Have you seen this before? I can't find a decent body of evidence-based literature on the topic.

I work in orthopedic surgery, and see this used relatively often. I am not a fan because, unlike the typical post-op delirium or opiate-related confusion that I see, I feel like my patients are living out their worst nightmares. From literature and text I see that it's used in anesthesia and status epilepticus. I have never personally seen it used for these things, but I have had many many patients on Ketamine drips.

[wtbcrna, MSN, DNP, CRNA]

As far as dosing goes, I have given between 0.1-0.3 mg/kg/hr--usually 0.2. And these replies makes perfect sense, theoretically. Whenever we take care of patients on ketamine drips, respiratory and CV function is definitely not our greatest issue (even though the amount of opiate in the patient is great). Preventing and reversing opioid tolerance also makes sense.

That Ncbi blurb is pretty interesting--in practice, the SEs (besides CV) are terrible. post-op n/v seems just as prevalent, and mental SEs are awful. Granted, these patients aren't completely delirious--if they try to get out of bed, they just need reminding of where they are, and they settle down. They tell you they're hallucinating, they don't know if they're dreaming, and that they feel miserable and foolish. While the self-awareness helps to keep them safe, I wouldn't wish this state on anyone.

A little bit of versed in these patients would probably go a long way to easing their discomfort. You might suggest that, if you unit allows IV versed, the Ortho Docs write for 1-2mg IV push q 2hr prn for moderate to severe anxiety/delirium.

[organichombre, ADN, BSN, MSN, LPN, RN]

My concern is that with ketamine being an anesthetic our facility will feel that the benefits do not outweigh the risks, ie. quicker ambulation, better pulmonary toileting, etc., vs. possible injuries r/t improper dosing of drug.