IV Ketamine Infusion

Importance of Ketamine

Ketamine is one of only two anesthetics listed by the World Health Organization (WHO) as an “essential drug. WHO is a specialized agency of the United Nations concerned with international public health.

Their essential drugs are “those drugs that satisfy the health care needs of the majority of the population; they should therefore be available at all times in adequate amounts and in appropriate dosage forms, at a price the community can afford”. The World Health Organization’s “essential drugs” form the basis for many countries’ national drug policy.

History of Ketamine

Ketamine is not a new drug. It has been used for five decades in human and veterinarian medicine. Ketamine is an anesthetic drug that was introduced into clinical practice in 1970.1  At anesthetic doses it results in a complete loss of consciousness while preserving certain protective reflexes.

That has made it attractive to anesthesiologists in selective patients. While it does stimulate opiate receptors, much like morphine, its NMDA receptor antagonism at subanesthetic doses is thought to be much more important in the treatment of chronic pain and psychiatric disorders. Blocking the NMDA receptor and preventing the passage of ions through the channel interrupts pain signal transduction, giving central pain centers a chance to “reboot”.

This often requires that a patient undergo a series of low dose ketamine infusions for dramatic or complete elimination of their chronic pain. Ketamine infusions have been most often used when other treatment modalities have failed. Certain types of pain considered to be “neuropathic” in origin have been most studied and are considered to be most responsive to ketamine therapy.

Intravenous Ketamine Infusion Therapy

Receiving Ketamine intravenously is the only method of administration that has been clinically proven to be effectively (and quickly) and thus the preferred method utilized by Pain MD Houston physicians. We have the highest levels of control over rate of infusion with the ability to titrate up or down based on the patient’s level of comfort and improvement.

If there are any undesired side effects, we are able to push medicine through the IV to manage nausea or anxiety that begins working within 1 minute. If any adverse effects persist, we can then discontinue the infusion.

Each infusion will be consistent, not necessarily experience the same, however IV enables our physicians the ability to provide continuity of care which is critical to optimize for best outcomes of Ketamine. We will know exactly (down to the microgram even) how much medicine you have received. This allows us the ability to create baseline treatments for future sessions.

Reference Materials

For CRPS/RSD

Analgesic Response to Intravenous Ketamine Is Linked to a Circulating microRNA Signature in Female Patients With Complex Regional Pain Syndrome.

Complex regional pain syndrome: An optimistic perspective.

Rational pain management in complex regional pain syndrome 1 (CRPS 1)–a network meta-analysis.

Pain relief is associated with improvement in motor function in complex regional pain syndrome type 1: secondary analysis of a placebo-controlled study on the effects of ketamine.

Outpatient intravenous ketamine for the treatment of complex regional pain syndrome: a double-blind placebo controlled study.

For Depression

Single i.v. ketamine augmentation of newly initiated escitalopram for major depression: results from a randomized, placebo-controlled 4-week study.

Pharmacologic approaches to treatment resistant depression: Evidences and personal experience.

Ketamine and Other NMDA Antagonists: Early Clinical Trials and Possible Mechanisms in Depression.

R-ketamine: a rapid-onset and sustained antidepressant without psychotomimetic side effects.