How is ketamine administered in the treatment of complex regional pain syndrome (CRPS)?

Updated: Jun 20, 2018
  • Author: Gaurav Gupta, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Methods of ketamine infusion include the following:

  • Hospital-based

    • A 5-day inpatient stay allows ketamine to be infused through an IV line starting at a dose of 20 mg/h of ketamine, which is increased by 5-mg increments to a maximum of 40 mg/h. Clonidine 0.1-0.2 mg daily or bid is used as an adjunct. Lorazepam 1-2 mg is useful when dysphoria or hallucinations occur. Other medications can be used to treat problems such as nausea, vomiting, and headaches.

    • Following discharge from the hospital, patients are enrolled in an outpatient infusion program. Initially, they are treated 1-2 times per week with a 4-hour IV infusion of 100-200 mg of ketamine. The frequency of outpatient treatment is reduced over time to 2 outpatient treatments per week, every other week for 1 month, then 1 treatment every other week for a month, then monthly for 3 months, and then every 3 months. This treatment approach is a guideline; some patients require more frequent treatments and some require close follow-up with monthly intersession outpatient evaluations. [134, 137]

  • Outpatient: Recommendations vary; however, one experienced and published physician advises 10 daily treatments over 2 consecutive weeks in an outpatient infusion suite. Patients received from 70-200 mg/d of ketamine in titrating doses over the 10-day time frame and then placed in the outpatient weaning program as previously described. [134, 137]

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