Introduction

S-ketamine (Ketanest-S®) is increasingly popular as an adjuvant to opioids in the treatment of cancer pain. The first

reason to start with S-ketamine is that it is a possible therapy for neuropathic pain due to nerve damage by a tumor. A

second reason to give S-ketamine is to prevent or treat the tolerance to opioids. In case reports and studies it is often

administrated parenterally, but there are some reports about oral administration, which is more convenient for the patient.

Advices about its dosage vary.

Methods

Retrospectively the medical records were studied of all patients who received S-ketamine orally since we started using this

treatment in January 2003. We studied both the patients who received S-ketamine orally from start and those in whom the

administration was converted from parenteral to oral administration.

Results

From January 2003 – March 2004 14 patients were treated with S-

ketamine. In 9 of them (64%) S-ketamine was administered orally. All 9

patients were in the palliative phase of advanced cancer and in all cases

pain was managed multidisciplinary. They received S-ketamine adjuvant

to parenteral or transdermal opioids.

Five patients started with parenteral administration of S-ketamine

resulting in a pain relief in all. S-ketamine was converted after 4-8 days

to oral administration, with a satisfying result in 4 of them. Three patients

were able to decrease opioids, 1 patient was able to stop opioids.

Four patients started with S-ketamine orally with no pain relief. Three of

them shifted to parental S-ketamine with a satisfying effect in only one of

them. For 2 patients it was not possible to reach pain relief, despite

increasing opioids.

Conclusion:

S-ketamine is a useful adjuvant to opioids in complex pain problems. It seems rational to try to convert to oral administration, which is more convenient for the patient, but only after titrating the dose parenterally.

S-ketamine as an adjuvant analgesic: effectiveness of oral administration

H. de Graaf-Waar, RN, CNS¹; P.J. Lieverse, MD²; A.J.E.F. de Wit, RN, CNS¹; L. van Zuylen, MD, PhD¹ 1

Department of Medical Oncology, 2

Department of Anesthesiology, Erasmus MC Daniel den Hoed Cancer Center,

Rotterdam, the Netherlands. H.i.degraaf@erasmusmc.nl

Patient Characterics

Gender: 2 male, 7 female

Mean age: 60 years (range 43-76)

Diagnosis

Melanoma 2

Breast cancer: 2

Lung cancer: 2

Head/neck cancer: 2

Osteo sarcoma 1

Opioids

Morphine: 3

Fentanyl (t.d.) 3

Hydromorphine: 2

Epiduraal/ intrathecaal: 1

V Reason to start S- ketamine

Uncontrolled pain: 2

Opioids rescue insufficient: 2

Nausea by opioids: 1

Missing: 4

Side effect of S-ketamine

Hallucinations: 2

V

Start S-ketamine

Total

start sc

start iv

start oral

Convertion Stop

1

1

sc to oral

3

3

iv to oral

2

2

Oral to sc

2

2

Oral to iv

1

1

Total

3

2

4

9