Ketamine as an adjuvant to opioids for cancer pain
Cochrane Database of Systematic Reviews June 28, 2017 Rae Frances Bell, Christopher Eccleston, Eija Kalso 246 citations
Evidence is insufficient to assess the benefits and harms of adding ketamine to opioids for refractory cancer pain. Three small trials (20, 10, and 185 participants) were included. Two older, very small studies reported reduced pain and opioid needs with ketamine, but a newer, larger placebo-controlled trial found no difference in pain intensity between groups. Rapid dose escalation of subcutaneous ketamine to 500 mg did not show clinical benefit and nearly doubled adverse events, including serious ones like cardiac arrest. The overall quality of evidence is very low, meaning the true effect is highly uncertain.