Hi guys.
I would appreciate your thoughts.
As a postop analgesic adjunct for major open abdominal surgery, most of the conventional research uses ketamine at conventional doses of i.e 0.1-0.2 mg/kg/hr.
Using ketamine in my regular practice for managing patients having complex prolonged open hepatobiliary surgery, I am using ketamine using "ultra-ultra-low doses: i.e 0.025-0.05 mg/kg/hr for 48 hrs with almost no side effects, yet outstanding analgesia (combined with other multimodal strategies i.e opioid PCA, NSAID and paracetamol). I also notice that at this dose there appears to be excellent opioid sparing properties.
Do you have any experience with using ketamine as these doses?
Bolus 0.5 mg/kg just after induction of GA, or we used 1 - 2 mg/kg/day for 48 hours with good results (see http://www.prolekare.cz/en/anaesthesiology-intensive-care-medicine-article/the-prospective-study-on-the-effect-of-a-preemptive-long-term-postoperative-administration-of-a-low-dose-ketamine-on-2755?confirm_rules=1).
I am emergency physician. 0.3-0.5 mg/kg Acut Pain condition in emergency medicine. This is analgesic dose but not sedation analgesic dose
I don't have the experience of ketamine as analgesic in the postop period in adults, however I found it very useful in a bolus dose immediately after surgery, especially in kids at a dose of 0.5 mg/kg. Will try your technique, thanks for sharing your experience
I'm using ketamine during in inguinal region pathologies and /or circumcision, but mostly alone do not provide adequate analgesia. Usually I am using ketamine (1-2 mg /kg/ hr IV push administration) with.local anesthesia (bupivacaine 0.1-0.5 ml/kg) for analgesia and sedation.
"Sedoanalgesia in pediatric daily surgery": Int J Clin Exp Med. 2013; 6(7): 576–582.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3731190/?report=classic
Very interesting at such low doses
Our research was looking at use for anaesthesia (sedation/ analgesia) doses, combined with propofol at different ratios
We modelled on the McFarlan regime (initial bolus dose followed by an infusion) and then reductions in the McFarlan regime thereafter, and found rates of 15-50µcg/kg/min were satisfactory up to 90 min anaesthesia in combination with propofol.
So, pure analgesia use is 60 times lower dose, albeit as part of a multimodal strategy
I don't think our work is easily applicable to your patients – awake with pure analgesia aims. The ultra-low dose numbers are very interesting though.
Do you use a loading dose? We found LD 15-16 times the per minute dose rate were useful. Again, with an aim of early loss of conscious being the aim.
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