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The most common complication of herpes zoster (shingles) is postherpetic neuralgia (PHN), a severe, deep, burning, or jabbing pain that persists for months and often years after resolution of zoster rash. Although gabapentin1 and topical lidocaine2 are the only federally approved drugs to manage PHN, the many other agents being prescribed for PHN indicate that better symptomatic therapies are needed.
Ketamine hydrochloride is an NMDA receptor antagonist that has been useful IV for neuropathic pain in patients with various conditions, including PHN.3 A topical form reduced sympathetically mediated pain in five patients,4 but it has not been used for PHN. We examined the effectiveness of topical ketamine in 23 PHN patients.
Methods.
Ketamine preparation.
Soybean lecithin granules (250 g; Spectrum LE 102) were mixed with 150 mL isopropyl palmitate (Aldrich Chemical #29–178–1, Milwaukee, WI). The mixture was stirred at least 12 hours until a uniformly dark, amber-colored solution was obtained. Ketamine (10 mL; Ketalar N0071–4582–10, 50 mg/mL) …
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