Ketamine Infusion WHAT IS KETAMINE?

Ketamine is best described as a “dissociative anesthetic” medicine and has been used in anesthesia and pain medicine for a number of years now. More recently ketamine is being used in the treatment of conditions such as:

• Neuropathic (nerve) pain • Reversing the pain associated with • Migraines sensitisation of the nervous system • Fibromyalgia/complex widespread pain • Reduction of harmful opioid medication use disorders • Depression and post-traumatic stress disorder • Complex regional pain syndrome (CRPS) (PTSD) • Phantom limb pain

HOW DOES KETAMINE WORK?

Ketamine exerts its e!ect via a myriad of pathways. However, it is ketamine’s action on a nerve receptor called NMDA (N-methyl-D-aspartate) that seems to be most significant. Activation of the NMDA receptor plays an important role in pain, mood, cognition and neural sensitisation. Ketamine acts to block the action of the NMDA receptor and “reset” the amplified pain receptors and repair damaged nerves. HOW IS A KETAMINE INFUSION DONE?

Ketamine infusions can be done as a series of treatments as an outpatient or as a continuous infusion over several days as an inpatient in hospital. Your doctor will have discussed this with you beforehand.

Outpatient • You will present to The Anodyne Centre for a short-day admission. • You will be connected to the infusion for a period of 2-3 hours and a subsequent short period of observation.

• You can expect the entire process to last up to 5 hours before you will be discharged home.

• You will be admitted to St John of God Subiaco Hospital for Inpatient a period of 6 days and you will be connected to the infusion continuously for a period of 5 days.

• During the initial 2-3 days your doctor will aim to get you to the “optimal” dose before leaving the infusion on for the next 2-3 days.

• Once completed you will have the infusion gradually tapered o! over 8-12 hours before a several hours period of observation.

Ketamine can be given via a number of di!erent ways. You will likely be receiving it as either an IV (intra- venous, in the vein) or SC (subcutaneously, under the skin) infusion. If you are an inpatient the needle will be changed and repositioned every 24 hours to avoid infection and the infusion line will be changed every 72 hours.

During your treatment you will have regular observations taken from the nursing sta! including monitoring of your heart rate, blood pressure, respiratory rate, temperature, oxygen saturation and pain scores. Ketamine can cause changes to these parameters and they will return to normal after you have completed the treatment.

KETAMINE INFUSION ARE THERE ANY SIDE EFFECTS?

Like all drugs ketamine is not without its potential side e!ects. Everyone has a di!erent tolerance to ketamine and can vary according to the condition being treated. You may not see any side e!ects, only one or more. These can be counteracted with other medications, reducing the dose/rate or stopping the infusion temporarily. These side e!ects will usually stop once the ketamine infusion has been ceased. Further dose increases will be made according to how you are feeling. Some potential side e!ects are:

• Euphoria or dysphoria • Nausea and/or vomiting • Dizziness and/or light headedness • Constipation • Confused or feeling “drunk” • Headaches • Vivid dreaming • Trouble with urination • Visual disturbances (double vision, blurry • Jerky movements vision, hallucinations) • Allergic reactions are rare

Other potential complications can occur as part of being in hospital. These can include:

• Blood clots: can be e!ectively prevented by keeping active such as walking around ward • Infection at site of needle: nurses will regularly change needle site to prevent this

If you are pregnant, have any serious cardiac, liver, psychiatric or neurological conditions, or have had a previous allergic reaction to ketamine, then a ketamine infusion may not be suitable for you. Your doctor will have assessed this before your treatment.

We recommend that you do not sign any legally binding documents, drive a motor vehicle or operate machinery during and for 24 hours after stopping the ketamine infusion.

KETAMINE INFUSION WILL I NEED ANY OTHER MEDICATIONS? WILL I NEED MY USUAL PAIN MEDICATIONS IN HOSPITAL?

You will not require any additional analgesia outside of what you are currently using. During your ketamine infusion you may receive other medications to assist with any potential side e!ects. This can include medications for:

• Nausea: ondansetron, domperidone, haloperidol, lorazepam • Agitation, insomnia, feeling unsettled: lorazepam, diazepam, haloperidol, clonidine • Blood pressure and heart rate changes: clonidine

WHAT HAPPENS BEFORE THE INFUSION?

In most cases you will not need any specific preparation before the ketamine infusion. In some instances, you may be required to complete an ECG and blood tests (liver function). You will be informed by your doctor if this is required.

WHAT HAPPENS AFTER THE INFUSION? HOW EFFECTIVE IS A KETAMINE INFUSION?

Some patients may feel unsettled or have to a month after the treatment and some patients increased pain for several days after stopping the may require several infusions before a benefit is infusion. This unsettled state and increased pain seen. Furthermore, a reduction in pain intensity is usually self resolves within a few days, but can be just one measure of success. Other areas include reduced by taking lorazepam for up to a week after improvement in function, psychological and discharge. Your doctor will advise you prior to your emotional wellbeing, improvement to sleep and discharge if you will need any extra medication. quality of life, and reduction in opioid analgesia.

The e!ectiveness of a ketamine infusion does In chronic pain, benefits can last anywhere from depend on the condition being treated and several weeks to months. In depression results are individual di!erences. The expected outcome typically immediate, but tend to wear o! much more varies from patient to patient and it is di!icult to quickly (usually within a few weeks). Your doctor predict your outcome before the infusion. Some will determine on a case by case basis whether patients see an improvement during the infusion, continued treatment with ketamine is warranted. but in many patient’s results are not seen for up

IS A KETAMINE INFUSION RIGHT FOR YOU?

If you think a ketamine infusion may be right for you talk to your doctor about it. If you would like any further information or would like to see one of our doctors please do not hesitate to contact The Anodyne Centre. When it comes to tackling pain, we’re better together

177 York St, Subiaco WA 6008 (08) 6166 3788

THEANODYNECENTRE.COM.AU