Original Article| Volume 18, ISSUE 6, P372-377, December 2017

Ketamine for Pain Management—Side Effects & Potential Adverse Events


      An old anesthetic agent, ketamine is finding new use in lower doses for analgesic purposes. There are concerns stemming from its potential side effects—specifically psychomimetic effects. These side effects are directly related to dose amount. The doses used for analgesic purposes are much lower than those used for anesthesia purposes. A literature review was performed to ascertain potential side effects and/or adverse events when using ketamine for analgesia purposes. The search included CINAHL, PubMed, and Ovid using the search terms “ketamine,” “ketamine infusion,” “pain,” “adverse events,” “practice guideline,” and “randomized controlled trial.” Searches were limited to full-text, peer-reviewed articles and systematic reviews. Initially 1,068 articles were retrieved. The search was then narrowed by using the Boolean connector AND with various search term combinations. After adjusting for duplication, article titles and abstracts were reviewed, leaving 25 articles for an in-depth analysis. Specific exclusion criteria were then applied. The literature supports the use of ketamine for analgesic purposes, and ketamine offers a nonopioid option for the management of some pain conditions. Because ketamine is still classified as an anesthetic agent, health care institutions should develop their own set of policies and protocols for the administration of ketamine. By using forethought and understanding of the properties of ketamine, appropriate care may be planned to mitigate potential side effects and adverse events so that patients are appropriately cared for and their pain effectively managed.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Pain Management Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Azari P.
        • Lindsay D.R.
        • Briones D.
        • Clarke C.
        • Buchheit T.
        • Pyati S.
        Efficacy and safety of ketamine in patients with complex regional pain syndrome: A systematic review.
        CNS Drugs. 2012; 26: 215-228
        • Coley K.C.
        • Williams B.A.
        • DaPos S.V.
        • Chen C.
        • Smith R.B.
        Retrospective evaluation of unanticipated admissions and readmissions after same day surgery and associated costs.
        Journal of Clinical Anesthesia. 2002; 14: 349-353
        • Gaskin D.J.
        • Richard P.
        The economic cost of pain in the United States.
        Journal of Pain. 2012; 13: 715-724
        • Joshi G.P.
        • Beck D.E.
        • Emerson R.H.
        • Halaszynski T.M.
        • Jahr J.S.
        • Lipman A.G.
        • Nihira M.A.
        • Sheth K.R.
        • Simpson M.H.
        • Sinatra R.S.
        Defining new directions for more effective management of surgical pain in the United States: Highlights of the inaugural surgical pain congress.
        The American Surgeon. 2014; 80: 219-228
        • Jouguelet-Lacoste J.
        • La Colla L.
        • Schilling D.
        • Chelly J.E.
        The use of intravenous infusion or single dose of low-dose ketamine for postoperative analgesia: A review of the current literature.
        Pain Medicine. 2015; 16: 383-403
        • Keller D.S.
        • Smalarz A.
        • Haas E.M.
        Developing a tool to measure pharmacoeconomic outcomes of post-surgical pain management interventions.
        Journal of Medical Economics. 2016; 19: 91-100
        • Lexicomp Online
        2016 (Retrieved from) (Accessed July 27, 2016)
        • McNicol E.D.
        • Schumann R.
        • Haroutounian S.
        A systematic review and meta-analysis of ketamine for the prevention of persistent post-surgical pain.
        Acta Anaesthesiologica Scandinavica. 2014; 58: 1199-1213
        • Niesters M.
        • Martini C.
        • Dahan A.
        Ketamine for chronic pain: Risks and benefits.
        British Journal of Clinical Pharmacology. 2014; 77: 357-367
        • O'Connell N.E.
        • Wand B.M.
        • McAuley J.
        • Marston L.
        • Moseley G.L.
        Interventions for treating pain and disability in adults with complex regional pain syndrome-an overview of systematic reviews (review).
        The Cochrane Database of Systematic Reviews. 2013; : CD009416
        • Patil S.
        • Anitescu M.
        Efficacy of outpatient ketamine infusions in refractory chronic pain syndromes: A 5-year retrospective analysis.
        Pain Medicine. 2012; 13: 263-269
        • Peltoniemi M.A.
        • Hagelberg N.M.
        • Olkkola K.T.
        • Saari T.I.
        Ketamine: A review of clinical pharmacokinetics and pharmacodynamics in anesthesia and pain therapy.
        Clinical Pharmacokinetics. 2016; 55: 1059-1077
        • Prommer E.E.
        Ketamine for pain: An update of uses in palliative care.
        Journal of Palliative Medicine. 2012; 15: 474-483
        • Schwartzman R.J.
        • Alexander G.M.
        • Grothusen J.R.
        • Paylor T.
        • Reichenberger E.
        • Perreault M.
        Outpatient intravenous ketamine for the treatment of complex regional pain syndrome: A double-blind placebo controlled study.
        Pain. 2009; 147: 107-115
        • Sener S.
        • Eken C.
        • Schultz C.H.
        • Serinken M.
        • Ozsarac M.
        Ketamine with and without midazolam for emergency department sedation in adults: A randomized controlled trial.
        Annals of Emergency Medicine. 2011; 57: 109-114.e2
        • Sigtermans M.
        • van Hilten J.
        • Bauer M.
        • Arbous M.
        • Marinus J.
        • Sarton E.
        • Dahan A.
        Ketamine produces effective and long-term pain relief in patients with complex regional pain syndrome type I.
        Pain. 2009; 145: 304-311
        • Strayer R.J.
        • Nelson L.S.
        Adverse events associated with ketamine for procedural sedation in adults.
        American Journal of Emergency Medicine. 2008; 26: 985-1028
        • World Health Organization Expert Committee on Drug Dependence Thirty-seventh meeting
        Ketamine (INN): Update Review Report.
        2015 (Retrieved from) (Accessed June 15, 2016)