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Background and Aims Although several studies have demonstrated efficacy of low-dose intravenous ketamine infusions in the perioperative period, there is little to no research investigating the use of high dose ketamine boluses for phantom limb during the acute postoperative period. This case demonstrates the success use of high dose ketamine to alleviate acute, postoperative, phantom limb pain following electrode implantation and total shoulder with proximal humeral replacement for transdermal osseointegration, after failing all other traditional postoperative phantom limb pain regimens.

Methods Direct patient care as well as retrospective chart review.

Results The patient was extubated in the OR and admitted to the ICU postoperativley, for pain control and started on the following pain regimen by the acute pain service: Ketamine gtt at 0.3mg/kg/hr, Subutex 8mg TID, Robaxin 500mg QID, Acetaminophen 1g TID, Lyrica 75mg TID, and IV Dilaudid

0.5 mg q3H PRN for breakthrough. Over the course of the next eight days patient also received daily IV ketamine boluses by a Physician, in 20mg increments, every 10 minutes for up to 5 doses, titrated to effect. The patient received between 60-100 mg of ketamine total during each ‘bolus session’ which occurred twice a day.

Conclusions This case contributes to the experimental evidence that high dose ketamine can be used safely to achieve analgesia for refractory, phantom limb pain during the acute, postoperative period. High dose ketamine can be incredibly effective in achieving analgesia in refractory, acute, postoperative phantom limb pain.