1. 2025;28;E689-E694Assessment of Three Regimens of Ketamine Infusion in Complex Regional Pain Syndrome: A Randomized Prospective Comparative Study
   Prospective Study
   Aml Magdy Abo Elsafa, MSc, Hesham Ibrahim El Tatawy, MD, Ashraf Elsayed Alzeftawy, MD, and Mohamed Elsayed Afandy, MD.

BACKGROUND: Ketamine helps in the management of complex regional pain syndrome (CRPS) by blocking N-methyl-D-Aspartate receptors, reducing inflammation, relieving pain, and offering antidepressant effects.

OBJECTIVES: To investigate how 3 sub-anesthetic doses of ketamine infusions aid pain reduction in CRPS patients.

STUDY DESIGN: A randomized prospective comparative study 

METHODS: This study was carried out on 75 men and women over 21 years of age who were diagnosed with CRPS and categorized as I or II according to the physical status classification system used by the American Society of Anesthesiologists. Patients were divided into 3 groups and given ketamine infusions over a period of 6 hours at doses ranging from 0.1 to 0.35 mg/kg/h, with a maximum dose of 24 mg/h. Three days of treatment were given to Group A, 5 days to Group B, and 7 days to Group C. 

RESULTS: The scores on the Brief Pain Inventory—Short Form and on the numerical rating scale were significantly lower in groups B and C than in group A (P < 0.05) at the first, second, and third months. Nevertheless, no significant differences were observed between group B and group C at the same intervals. Side effects associated with ketamine infusion were significantly lower in group A than groups B and C. Similarly, the side effects were also significantly lower in group B than group C (P < 0.05). 

LIMITATIONS: The study had no control group and was performed in a single center with a short period of follow-up.

CONCLUSIONS: A 5-day regimen of ketamine infusion was associated with the best outcome for pain control and minimal side effects. Meanwhile, the 7-day regimen of ketamine infusion had the greatest number of side effects. The 3-day period of infusion had the lowest number of side effects and offered the least pain control.

KEY WORDS: Ketamine, receptors, N-methyl-D-aspartate, pain measurement, analgesics, chronic pain, complex regional pain syndrome, anesthetics, infusions, parenteral