Evaluation of the “Kosish Cocktail” in Treating Severe Pain in “Home Care” in Morphine-naïve Communities

BACKGROUND: Inavailability of morphine continues to plague most parts of India. Good palliative care must, however, focus on resources that are locally available, culturally acceptable, financially affordable, and easily applicable. These factors were all integral to the development of the “Kosish cocktail” for use in severe pain. This cocktail is a mixture of ketamine, midazolam, pentazocine lactate, and other adjuvants for use in the domiciliary set-up as intermittent subcutaneous injections in a morphine-naïve community. Our aims and objectives were: (1) To assess the efficacy of the “Kosish cocktail” in treating severe pain in terminally ill patients; (2) To assess the safety profile and note any adverse effects; (3) To evaluate its use in domiciliary set-ups in terms of safety and efficacy; (4) To empower the patient and the family in the process of patient care. MATERIALS AND METHODS: Eight patients with advanced cancer and severe pain, who were already on WHO Step II drug therapy, were enrolled for this study. The cocktail was administered subcutaneously in every four hours and SOS. Subjective and objective parameters were recorded and the data analyzed using Student’s t-test with a P<0.05 being considered significant. RESULTS: There was a statistically significant improvement in the subjective parameters 12 hours after the initiation of therapy, except for the persistence of fatigue. CONCLUSIONS: On the basis of this qualitative study, the authors confirm the efficacy and safety of the use of the Kosish cocktail in treating severe pain, and strongly recommend it for newly started hospices, especially for use in the domiciliary set-up.