Intraoperative Ketamine Dosing For Analgesia

In the world of multimodal analgesia, ketamine is a wonderful drug with other pain medications (opioids, NSAIDs, etc.). It helps attenuate opioid-induced hyperalgesia, antagonizes NMDA receptors, and provides a state of disocciative amnesia.

ketamine-structure
Ketamine

I’ve not found a great consensus about how to dose ketamine intraoperatively as an analgesia adjunct. The literature quotes different doses for infusions and boluses, but here’s a simple formula which works for me assuming a non-ketamine induction of general anesthesia.

I bolus 0.5 mg/kg IV ketamine before incision, then bolus 0.2 mg/kg IV ketamine every 30 minutes until an hour before the end of the case. I’ve done this plenty of times in adult and pediatric patients with no significant emergence delirium and comfortable patients post-operatively. 🙂

How do you use ketamine intraoperatively?

You might also like

Leave A Reply

Your email address will not be published.

2 Comments
  1. Ben says

    For my chronic pain patients, especially those undergoing large spine operations I’ll do a ketamine/lidocaine infusion. In a 20cc syringe of 2% lidocaine I’ll mix 1cc of ketamine @ 100mg/cc. I’ll run the Lidocaine infusion at 1 mg/kilogram/hour, Which correspondingly doses the ketamine at 0.25mg/ kilogram/hour. I turn it off about about 20 minutes before the end of the case.

    1. Rishi says

      That sounds like a streamlined way of delivery those infusions! I’m very much a fan of lidocaine and ketamine infusions in chronic pain patients undergoing lengthy procedures! 🙂