Oral administration of parenteral S-ketamine in wound care when ‘conventional’ medication regimens are not sufficient: a case series

Wound care procedures are often considered very painful. This pain can have severe effects on patients' wellbeing and be associated with delayed wound healing. Opioids can be of use during wound care; however, they are not always sufficient. Ketamine can be a successful alternative or adjunct, due to its pharmacological profile. In the Maastricht University Medical Centre+, the Netherlands, insufficient pain relief during wound care is often combatted by performing the procedure under sedation or even general anaesthesia. This case series describes four cases of patients successfully treated by oral administration of 0.5-1mg/kg parenteral S-ketamine during wound care on the ward. No changes in respiratory function or haemodynamics were observed in the four patients. S-ketamine has a higher analgesic potency than the racemic mixture, while having fewer side effects. When administered orally, S-ketamine undergoes significant metabolism, to norketamine. While one patient reported a side effect of oral administration-being in a dissociative state-this was not experienced as negative by the patient or the caregivers. A reduction in pain during wound care improves patient satisfaction. Reduced stress and pain might also contribute to wound healing. More research into dose, efficacy and safety in larger patient groups is needed.