The clinical presentation and diagnosis of ketamine-associated urinary tract dysfunction in Singapore

Ketamine is a short-acting anaesthetic agent that has gained popularity as a 'club drug' due to its hallucinogenic effects. Substance abuse should be considered in young adult patients who present with severe debilitating symptoms such as lower urinary tract symptoms, even though the use of controlled substances is rare in Singapore. Although the natural history of disease varies from person to person, a relationship between symptom severity and frequency/dosage of abuse has been established. It is important to be aware of this condition and have a high degree of clinical suspicion to enable early diagnosis and immediate initiation of multidisciplinary and holistic treatment. A delayed diagnosis can lead to irreversible pathological changes and increased morbidity among ketamine abusers.

A case of burst ketamine therapy for opioid-resistant pain

<b>Purpose</b>: We report a patient with opioid-resistant pain in whom favorable pain control could be achieved with burst ketamine therapy. <b>Case</b>: A female in her fifties had been followed up due to pain associated with recurrence in the right thoracic cavity at the thoracotomy site after surgery for mesopharyngeal and hypopharyngeal cancer, free jejuna autograft reconstruction, and permanent tracheotomy. Oral drug administration became impossible due to dysphagia and nausea, and she was admitted because of unfavorable pain control. Although the opioid dose was increased, pain did not improve, and rescue medication was also ineffective. Opioid-resistant pain was suspected, and burst ketamine therapy was performed. The therapy was initiated with the continuous intravenous administration of 100 mg/day ketamine, which was increased to 300 mg/day and 500 mg/day after 24 and 48 hours, respectively, according to the degree of pain, and was continued for 5 days. As analgesic effects of morphine were obtained during ketamine administration, a higher dose of morphine was administered; as a result, a favorable pain control outcome was achieved, and the patient returned home. <b>Conclusion</b>: Burst ketamine therapy may be effective for the treatment of opioid-resistant pain. Palliat Care Res 2011;6(2): 358-364