Implementing an intravenous ketamine protocol for acute pain in the medical-surgical setting

A subanesthetic intravenous ketamine infusion is a safe and effective acute pain management modality for moderate to severely painful surgical procedures and may be useful in patients who are at increased risk for opioid-related adverse events. Despite its safety profile, intravenous ketamine is often restricted to the intensive care unit, which results in decreased patient access to this effective therapy. For clinicians who wish to implement an intravenous ketamine protocol in the medical-surgical setting, there are few resources available. In this brief report, we present our ketamine infusion protocol for acute pain and the clinical and financial outcomes 1 year after implementation. In our experience, ketamine infusions on the medical-surgical ward are safe and cost-effective when an established acute pain service protocol is followed. Nurse practitioners play an essential role in increasing patient access to intravenous ketamine infusions and leading change by collaborating with stakeholders to develop a protocol, training nurses and interdisciplinary team members, and providing ongoing support to nursing staff.

Automated summary

Intravenous ketamine infusion is a safe and effective acute pain management method for surgical procedures, especially for patients at higher risk for opioid-related adverse events. However, restricted access to intravenous ketamine in the medical-surgical setting limits its effectiveness. In this report, the authors present their ketamine infusion protocol and demonstrate the safety and cost-effectiveness of ketamine infusions on the medical-surgical ward, highlighting the essential role of nurse practitioners in increasing patient access.