Background Refractory cancer pain is often difficult to manage. Ketamine is a drug with evidence of efficacy in the treatment of chronic cancer pain.

Purpose To evaluate the efficacy and safety of ketamine rinse solution in paediatric patients with refractory cancer pain.

Material and methods We report on a paediatric oncology patient who presented with painful conditions refractory to conventional analgesic treatment. Intravenous ketamine was diluted to a final concentration of 10 mg/mL in sterile water to rinse. Mouth rinses with 3 mL (30 mg) once daily was prescribed, specifying two rinses daily if required. Efficacy was measured on a visual analogue scale for pain (VAS pain), the Clinical Global Impression – Global Improvement (CGI-I) Scale, and the reduction of dose or withdrawal of analgesic drug base. Safety was measured in terms of variation in some clinical parameters (blood pressure, heart rate, oxygen saturation) and onset of drug-related symptoms (feeling drunk, drowsiness, nausea, vomiting, nystagmus or hallucinations).

Results The case of a male patient 13 years of age [33 kg and 143 cm] is presented. The patient was receiving morphine chloride rescues until the treatment; morphine rescue was no longer needed on the second day of initiating treatment. The VAS pain score before rinsing was 9 and remained on 2 for 24 h after the rinse was applied, achieving a score of 0 on day four. CGI-I Scale at the end of the treatment score was 1 (Very much improved). The patient had no changes in clinical parameters. The total rinsing treatment time was four days, requiring two rinses the first day only. The pain stopped within 10 min of beginning the rinsing.

Conclusion Ketamine rinsing was effective and safe in our paediatric oncology patient with painful conditions refractory to standard analgesic treatment. Further studies are needed to strengthen our results.

References and/or acknowledgements Specially thanks Dr Manuel Cortiñas

No conflict of interest.