Clinicians shouldn't be put off by its reputation as an anaesthetic and drug of abuse

Ketamine is well known as an intravenous anaesthetic agent with analgesic properties. It is also becoming well known as a drug of abuse. Less well known, however, is the fact that oral ketamine is a useful analgesic agent in cancer and chronic non-malignant pain. Indeed, its reputation as a drug of abuse may be making clinicians overcautious about its use for pain relief.

In anaesthetic practice high plasma and brain concentrations of ketamine result in dissociative anaesthesia, amnesia, a rise in arterial pressure, increased heart rate and cardiac output, and raised intracranial pressure with relative preservation of airway reflexes and respiration. Ketamine became established for use in hypovolaemic patients and in difficult locations such as battlefields because of its safety. Reports have also suggested relatively few serious adverse effects using …