ketamine

• evidence still not great.
• consider 0.3mg/kg iv/sc for refractory pain (over 30-60 min).
• great drug for incident/turn pain starting at 10 mg IV/SC
• consider intranasal at 0.75mg/kg

TRAMADOL

• a synthetic opioid with analgesia provided via a weak OP3 (mu) receptor effect, and via inhibition of serotonin and noradrenaline reuptake. May provide neuropathic pain benefit.
• Has a low incidence of constipation, nausea and dizziness compared to other opioids. May cause seizures; use cautiously in patients with epilepsy, head trauma, brain metastases.
• serotonin syndrome and hypoglycemia.

pain power overview