Ketamine for pain relief in acute pancreatitis

Patients with acute pancreatitis are often admitted to critical care unit and present with a spectrum of multiorgan problems. The commonest presenting symptom of acute pancreatitis is upper abdominal pain. The pain can be very severe and refractory to the treatment with conventional analgesics. The pain not only adds to the patient's distress but may also have adverse effects on the cardio-respiratory systems, which can be affected by acute pancreatitis itself. The pain in acute pancreatits is usually controlled by conventional analgesics, morphine/pethidine PCA or epidural analgesia. But at times all these measures of pain control fail and additional methods of pain relief become necessary. We encountered a patient with acute pancreatits with severe abdominal pain in whom conventional methods of pain relief failed to provide adequate analgesia. The patient had respiratory impairment secondary to upper abdominal pain and improved pain relief avoided the possible need for invasive ventilation. We used an intravenous ketamine infusion to supplement the analgesic regimen with a significant improvement in pain relief without any adverse psycho mimetic effects. The probable mechanisms of action of ketamine in improving pain relief are discussed. On search of the literature, the use of ketamine for pain relief in acute pancreatitis has never been reported.