ketamine right after TIG surgery

[quilter]

I've been in discussion with Dr. Hibner's office about whether or not he can offer me anything. I need to see him for exam, but based on all the recent tests, PT reports, good response to recent pudendal block (via fluoroscopy & neurostim), increased pain with the sacral neurostimulator and since its removal, he thinks I'm probably a good candidate for re-do left PN decompression. Because I've been in pain 14 years (5+ years postop), he also recommends an immediate inpatient 5-day low-dose ketamine infusion while I'm in the hospital. This would be managed by Valley Pain, who I will have a consult with when I see Dr. H. Not committing to surgery yet, much to check out and think about. Wasn't fun the first time, though I was significantly better the first year postop, less the second, downhill since and now worse. Also need to consider other treaters.

I haven't really researched ketamine infusion and will now start via all the great info here. Will discuss all this in Phoenix (many weeks in the future), but until then, is ketamine more likely to be successful done in conjunction with decompression? I would also love to hear from anybody who has had this double procedure with Dr. Hibner and Valley Pain in the last year. Thanks!

[nyt]

I had a 2-day Ketamine infusion when I had my decompression in Sept 2012. I had it to stop the flare of my CRPS in my legs which it did help that due to surgery. Just a warning, when I was there in March 2013 for my botox I was told you have to pay up front for the Ketamine which is about $14,000 for the 5-day inpatient. I did 1 day as that was about $3700.

[quilter]

Thanks nyt. Totally blanked on asking Hibner's office about insurance coverage for ketamine (Medicare primary, private ins. secondary). Paying that much up front would be extremely difficult. Will ask them before planning the trip to Phoenix for multiple consults goes any further. My pain is localized 90% to the left pelvis, has never gone below the butt. The same carriers paid for nearly all of my Botox 2-1/2 years ago, so whatever he did to get it justified worked.

Hope you're doing better now. Take care!

[Amanda]

Hi Quilter

I actually think to combine a ketamine infusion immediately after surgery sounds like a sound idea to break the pain cycles....Dr Hibner is certainly looking into the multi disciplinary options as a pain consultant. I wonder if I had the same treatment would it have broken the CRPS element of my pain. I wish you good luck and would recommend you try this option if it is available for you via your insurance policy.

[TCB]

In patient Ketamine is expensive and not many of us can not afford $14,000 out of pocket plus periodic boosters depending on the results of the first round of treatment. I have had good results with out patient Ketamine and Lidocain costing on average $1300 a day plus travel expenses. Treatment times have varied from from 4-8 hours per day. I have done four 4-5 day outpatient treatments since June of 2012 and my pelvic pain levels are much improved. I would stress that each patient is different and the response to Ketamine depends on many factors and variables. My insurance has not covered much of my Ketamine treatment costs because my doc is out of network. My research shows that many of the 20 + or - docs who offer Ketamine infusions in the US charge anywhere from 800 -2500 a day for outpatient treatments. I could not afford to wait for the insurance companies to recognize the benefits of Ketamine. The waiting time for some docs who have had success getting insurance companies to pay for Ketamine is 3-4 years! I sincerely hope that you can find a way to try this cutting edge pain treatment and or surgery and get your pain under control!

TCB

[quilter]

When I had the Marcaine pump with my first Dr. Hibner PNE surgery, one line went directly to the PN and the other was to the incision. Is the ketamine placed just in the main IV line so it's centrally absorbed by the nervous system, or does a separate line target the specific repaired nerve? The reason I ask is that I have a separate nerve issue in the foot on the same side (3rd Morton's neuroma on the same toe after 2 prior surgeries) and was wondering if the ketamine might also help that - it would be icing on the cake if it works at all.

[nyt]

The Ketamine is placed in the main IV line.