Ketamine intravenous for PAIN management in adults

Who can administer

Administration RESTRICTED - see Appendix 1

Important information

  • This monograph refers to the use of the drug in pain management (unlicensed indication)
  • May only be used by anaesthetics, pain control team, critical care teams
  • Take great care in selecting correct strength. Independent 2nd person check is always required
  • Draw up ONLY the dose required into the syringe
  • Critical care bed required
  • If ketamine is required by the subcutaneous route - See QPulse CLN NM 0542
  • Stored in CD press, MDA regulations apply (storage and recording requirements)
  • See under Further information for details on contraindications
  • For Y-site compatibility see below

Available preparations

Ketamine Sintetica 100mg per 10ml ampoule - unlicensed (Stocked while licensed product is in short supply)

Ketalar 200mg per 20ml vial (10mg/ml)

Ketalar 500mg per 10ml vial (50mg/ml)

Reconstitution

Already in solution

If ampoule being used: draw up using a 5 micron filter needle

Infusion fluids

Sodium chloride 0.9% or Glucose 5%

Methods of intravenous administration

Bolus intravenous injection

  • Dilute to a concentration of 1mg/ml and administer required dose over at least 60 seconds
  • More rapid administration may result in respiratory depression and enhanced pressor response (ref 1)

Continuous intravenous infusion (for pain management)

  • Dilute to a concentration of 1mg/ml with infusion fluid (ref 1)
  • Administer via a syringe driver

Dose in adults

Usual dose (for pain management)(ref 3)

  • Bolus dose: give 1 to 2mg. May be repeated every five minutes as required up to a maximum dose of 20mg
  • Infusion: Give 1 to 5mg per hour
  • Contact pain team for further information regarding dose adjustments if required

Monitoring

  • Critical care bed

Further information

Relative contraindications: (ref 2)

  • Poorly controlled cardiovascular disease
  • Pregnancy, psychosis
  • Severe hepatic dysfunction (eg cirrhosis) (use with caution in those with moderate hepatic disease)
  • Elevated intraocular or intracranial pressure

The doses listed in this monograph are lower than those suggested in the literature- this is based on local expert opinion (ref 3)

Storage

Controlled drug

References

1. Injectable medicines guide, Medusa.nhs.uk Downloaded 11/12/2024

2. Consensus guidelines on the use of intravenous ketamine infusions for acute pain management. Regional anaesthesia and pain medicine VOl 43, no.5 July 2018

3. Local expert opinion, Dr Olivia Finnerty, Anaesthetist 10th December 2019

Therapeutic classification

General anaesthetic