Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Parallel session C Ketamine for complex acute surgical patients Dr Gillian Chumbley, Consultant Nurse – Pain Service, Imperial College Healthcare NHS Trust. Biography Gillian leads a team of nurses who manage both acute and chronic pain. She has worked in this field for 15 years and completed her PhD, evaluating the patient’s experience of patient-controlled analgesia (PCA), at St George’s Hospital Medical School in 2001. Her recent interest has been the use of lowdose ketamine for uncontrolled post-operative pain. She has chaired the London RCN and Pain Network Forum and she is a member of the National Consultant Nurses in Pain Management group. She has been a member of the South Thames Acute Pain Group for 4 years. Gillian recently assisted the British Pain Society with updating their guidance on the use of opioids for persistent non-cancer pain and she was an Editorial Advisor on the Challenge Pain for Nurses Project. She has applied for a two year clinical lectureship grant, which if successful, will enable her to research the role of activated NMDA receptors in the development of chronic post-surgical pain. Abstract Ketamine was introduced into clinical practice as a dissociative anaesthetic agent and analgesic in 1964 and low-dose infusions were used to treat acute pain as long ago as 1978 [1]. Despite the evidence to show that ketamine can be effective in the management of acute pain [2,3], its use in subanaesthetic doses for pain control is far from routine [4]. Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist. The NMDA receptor is normally dormant during routine physiological pain transmission, but becomes activated amid intense synaptic transmission [4]. Activated NMDA receptors are thought to be responsible for the development of central sensitization [1,5,6]; thus low-dose ketamine appears to be protective in the development of hyperalgesia and allodynia [1,4,6]. NMDA receptor antagonists have been shown to have a preventative analgesic effect [7]. This lecture will discuss the introduction of low-dose ketamine for acute pain relief at Imperial College Healthcare NHS Trust and present audit data. Patient selection will be discussed, along with the practical implications of administering ketamine on busy hospital wards. 1. Schug SA. New Uses for an Old Drug: The Role of Ketamine in postoperative pain treatment. ASEAN Journal of Anaesthesiology 2004; 5: 39-42. 2. Bell RF, Dahl JB, Moore RA, Kalso E. Perioperative ketamine for acute postoperative pain. Cochrane Database Systematic Review 2006; 1: CD004603. 3. Subramaniam K, Subramaniam B, Steinbrook RA. Ketamine as Adjuvant Analgesic to Opioids: A Quantitative and Qualitative Systematic Review. Anesthesia and Analgesia 2004; 99: 482-495. 4. Hocking G, Visser EJ, Schug SA, Cousins MJ. Ketamine: Does Life Begin at 40? Pain: Clinical Updates 2007; XV(3): 1-6. 5. Petrenko AB, Yamakura T, Baba H, Shimoji K. The Role of N-Methyl-DAspartate (NMDA) Receptors in Pain: A Review. Anesthesia and Analgesia 2003; 97: 1108-1116. 6. Schmid RL, Sandler AN, Katz J. Use and efficacy of low-dose ketamine in the management of acute postoperative pain: a review of current techniques and outcomes. Pain 1999; 82: 111-125. 7. McCartney CJL, Sinha A, Katz J. A Qualitative Systematic Review of the Role of N-Methyl-D-Aspartate Receptor Antagonists in Preventive Analgesia. Anesthesia and Analgesia 2004; 98: 1385-1400.