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Intravenous Ketamine Infusions for Chronic Pain

From the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists

Regional Anesthesia and Pain Medicine
June 5, 2018 - Online First
doi: 10.1097/AAP.0000000000000808

Cohen, Steven, P., MD; Bhatia, Anuj, MBBS, MD; Buvanendran, Asokumar, MD; Schwenk, Eric, S., MD? Wasan, Ajay, D., MD, MSc; Hurley, Robert, W., MD, PhD; Viscusi, Eugene, R., MD; Narouze, Samer, MD, PhD; Davis, Fred, N., MD; Ritchie, Elspeth, C., MD, MPH; Lubenow, Timothy, R., MD; Hooten, William, M., MD

Over the past 2 decades, the use of intravenous 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.

Guidelines were prepared for the following areas: 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. 

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