Oral Ketamine used as Analgesia in Cancer Patients in Al Forat Al Awsat Oncology Center
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Background: Cancer pain management is complicated and requires assessment, reassessment, and constant vigilance by health care providers. Inadequate pain management has serious consequences for the patient, physician, nurse, and the health care system. Ketamine is commercially available as injection solution. The routes of administration of ketamine include parenteral, oral, topical, intranasal and sublingual. Oral administration of ketamine is preferred in long term use.
Objective: To evaluate the effect of the use of oral Ketamine as analgesic in Cancer patients
Patients and Methods: This was a randomized single blind controlled clinical trial conducted at Al Forat Al Awsat Oncology center. A total of 112 patients with different types of cancer, aged 18 years or older were included, patients assigned into two groups; 56 patients in each and they were assigned to receive 30 mg ketamine orally three times a day for one month. The second group assigned to receive placebo. The preparation of oral ketamine solution was used by took, 10 ml of 5% ketamine was diluted by 70 ml of 5% glucose water and 20 ml of 20% hypertonic solution. The patients were trained by the researcher how to take the solution by using a disposable 10 ml syringe and to draw 6 ml at each dose. Numeric analogue scale used to assess the intensity of pain among the patients. The patients asked to rate their pain according to the Numeric analogue scale at each visit.
Results: The patients age ranged 26 – 65 years, with no significant difference between both groups. All patients in both groups had the higher NAS at baseline. After initiation of treatment with 90 mg/day of oral ketamine in three divided doses , dramatic change had been reported at each visit in ketamine group; the mean NAS score reduced significantly at the last visit; the mean NAS was 9.2 ± 3.1 and 1.6 ± 1.0, respectively, (P<0.001). No similar changes had been found in placebo group. Some patients needed to increase the doses of ketamine and or the interval till reach a mean dose of 163 ± 10 mg in 4 divided doses, 4 patients remained not responding. On the other hand, 4 patients still have severe and very severe pain at the end of study and they were not responding.
Conclusions: Oral Ketamine is effective, safe and well tolerated agent for the management of chronic severe pain in cancer patients and it recommended for the cancer patients not respond to conventional treatment, further studies with longer duration are highly suggested.
Keywords: Ketamine, oral ketamine as analgesia, cancer