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Infusions of Ketamine are used for the acute pain treatment in emergency departments and in the perioperative period in individuals with refractory pain. The doses are lower than those used for anesthesia; they are usually referred to as sub-anesthetic doses. Adjunctive to morphine or on its own, ketamine reduces morphine use, pain level, nausea, and vomiting after surgery. Ketamine is likely to be most beneficial for surgical patients when severe post-operative pain is expected and for opioid-tolerant patients.
Ketamine is especially useful in the prehospital setting, due to its effectiveness and low risk of respiratory depression. Ketamine has similar efficacy to opioids in a hospital emergency department setting for management of acute pain and for control of procedural pain. It may also prevent opioid-induced hyperalgesia and postanesthetic shivering.
For chronic pain, ketamine is used as an intravenous analgesic, particularly, if the pain is neuropathic. It has the added benefit of counteracting spinal sensitization or wind-up phenomena experienced with chronic pain. In multiple clinical trials, ketamine infusions delivered short-term pain relief in neuropathic pain diagnoses, pain after traumatic spine injury, fibromyalgia, and complex regional pain syndrome (CRPS). However, the 2018 consensus guidelines on chronic pain concluded that, overall, there is only weak evidence in favor of ketamine use in spinal injury pain, moderate evidence in favor of ketamine CRPS, and weak or no evidence for ketamine in mixed neuropathic pain, fibromyalgia, and cancer pain. In
particular, only for CRPS there is evidence of medium to longer term pain relief.
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Ketamine is a robust and rapid-acting antidepressant, albeit its effect is transient. Intravenous ketamine infusion in treatment resistant depression results in improved mood within 4 hours reaching the peak at 24 hours. The effect is diminished at 7 days, and most patients relapse within 10 days, although for a significant minority the improvement may last 30 days and longer. The main challenge with ketamine treatment is what to do when the anti-depressive action expires. The maintenance therapy with ketamine (from twice a week to once in two weeks) appears to be a promising option, although the evidence to firmly recommend it is
insufficient. Ketamine may also decrease suicidal thoughts for up to three days after the injection. Ketamine injecticon may be effective for bipolar depression, but the data on its use is scarce. where to buy ketamine in the USA