Prospective audit of short‐term concurrent ketamine, opioid and anti‐inflammatory (‘triple‐agent’) therapy for episodes of acute on chronic pain

Good, Phillip; Tullio, F; Jackson, Kate; Goodchild, Colin S; Ashby, Michael

doi:10.1111/j.1445-5994.2004.00727.x

Cited by 26 publications

(17 citation statements)

References 21 publications

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“…If pain is not treated at the appropriate times, injury to nociceptive nerves and central sensitization may be induced, leading to allodynia and hyperpathia. Hence, Good et al [27] suggested triple-agent therapy involving the co-injection of opioid analgesics, NSAIDs, and ketamine in the early period. This is similar to our method for patients undergoing Nuss surgery, a procedure which induces severe post-operative pain.…”

Section: Discussionmentioning

confidence: 99%

Effect of ketamine on intravenous patient-controlled analgesia using hydromorphone and ketorolac after the Nuss surgery in pediatric patients

Min

Kim

Jeong

et al. 2012

Korean J Anesthesiol

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BackgroundNuss surgery is preferred in pectus excavatum repair because this procedure produces excellent cosmetic results and prevents postoperative distressed pulmonary function. However, the procedure causes severe pain due to thoracic expansion. This study was designed to investigate the analgesic effect of small doses of ketamine on an intravenous patient-controlled analgesia (IV-PCA) using hydromorphone and ketorolac for pain control after Nuss surgery.MethodsForty-four patients undergoing elective Nuss surgery were randomly assigned to receive hydromorphone 3 µg/kg/hr, ketorolac 0.05 mg/kg/hr and ondansetron 0.1 mg/kg/day (Group HO, n = 22) or hydromorphone 3 µg/kg/hr, ketorolac 0.05 mg/kg/hr, ondansetron 0.1 mg/kg/day and ketamine 0.15 mg/kg/hr (Group HK, n = 22) via an IV-PCA pump after surgery. A blind observer evaluated each patient using the Modified Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) for the assessment of pain control. The total administered PCA volume, side effects and parents satisfaction with pain control were assessed at postoperative 1, 4, 8, 12, 24, and 48 hours.ResultsThere were no significant differences in Modified CHEOPS between the groups during postoperative 48 hours. The total PCA volume in group HK was significantly lower than that in group HO (P < 0.05). The side effects in both groups did not significantly differ except for pruritus. The levels of satisfaction from the parents were not significantly different between the groups.ConclusionsA small dose of ketamine on IV-PCA reduced the total administered dose of IV-PCA with hydromorphone and ketorolac and reduced the incidence of pruritus after the Nuss procedure in pediatric patients.

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Section: Discussionmentioning

confidence: 99%

Effect of ketamine on intravenous patient-controlled analgesia using hydromorphone and ketorolac after the Nuss surgery in pediatric patients

Min

Kim

Jeong

et al. 2012

Korean J Anesthesiol

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“…Pharmacologic management of cancer pain is a sequence of increasing steps for control (Good et al, 2005). In two case studies of patients with escalating and excruciating pain, low-dose ketamine provided analgesia that increasing doses of morphine and hydromorphone failed to achieve (Fine, 1999).…”

Section: Drug Descriptionmentioning

confidence: 98%

“…Severe cancer pain is persistent and interferes with activities of daily living (e.g., eating, sleeping), leading to depression and fatigue (Otto, 2001). According to Good, Tullio, Jackson, Goodchild, and Ashby (2005), the longer cancer pain is not controlled adequately, the more difficult controlling it becomes, as refractory pain later develops.…”

Section: Severe Cancer Painmentioning

confidence: 98%

“…The combination of ketamine and opioids can provide greater pain control and allows a decreased use of each agent. Ketamine administration with opioids controls almost all breakthrough pain without the problems related to high doses of opioids (Good et al, 2005). Less well known, however, is the fact that oral ketamine is a useful analgesic agent in cancer pain management.…”

Section: Drug Descriptionmentioning

confidence: 99%

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The Use of Ketamine as Adjuvant Therapy to Control Severe Pain

Campbell-Fleming

Williams²

2008

Clinical Journal of Oncology Nursing

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Ketamine used in conjunction with other analgesics has dissociative, analgesic, sedative, and amnesic properties. Ketamine potentiates opiates and analgesics, is rapid acting, and is relatively safe. The United Kingdom and United States use ketamine with opioids in adjuvant pain management for a variety of conditions, including cancer pain. Adults and children benefit from the analgesic effects of these medications, especially at the end of life when the reduction of severe cancer pain has refractory or dose-limiting effects. For adults, ketamine and opioids are administered by a patient-controlled analgesia pump. The medication combination has decreased use of opioids and increased activities of daily living. Nursing considerations include close monitoring of vital signs during the initial dosage and follow-up observations of the effectiveness of the medications. Vital signs are checked every four hours after the initial dosage along with evaluation of the effectiveness of the dosage and observation for signs of oxygenation of tissue. Patients have better mobility and quality of life when receiving ketamine as an adjuvant therapy, which promotes assistance with their nursing care. Side effects may occur from administering ketamine and include nausea, vomiting, dizziness, and emotional distress. Standard orders help alleviate problems with those symptoms.

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“…Management involves treating the underlying medical condition as well as the skin and using multiple analgesics to control severe ischaemic pain. 6 Dermatomyositis and malignant melanoma: a rare association that worsens prognosis?…”

Section: Calciphylaxis: Fatal Arteriosclerosis Of Uncertain Mechanismmentioning

confidence: 99%

Calciphylaxis: fatal arteriosclerosis of uncertain mechanism

Wong

Miller

Cross

et al. 2014

Internal Medicine Journal

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Prospective audit of short‐term concurrent ketamine, opioid and anti‐inflammatory (‘triple‐agent’) therapy for episodes of acute on chronic pain

Cited by 26 publications

References 21 publications

Effect of ketamine on intravenous patient-controlled analgesia using hydromorphone and ketorolac after the Nuss surgery in pediatric patients

Effect of ketamine on intravenous patient-controlled analgesia using hydromorphone and ketorolac after the Nuss surgery in pediatric patients

The Use of Ketamine as Adjuvant Therapy to Control Severe Pain

Calciphylaxis: fatal arteriosclerosis of uncertain mechanism

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