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Low-dose ketamine provides potent, opioid-sparing analgesia via NMDA antagonism with minimal respiratory depression and generally stable hemodynamics—ideal in opioid tolerance. It improves ventilator synchrony, mitigates central sensitization, and reduces total opioid requirement. Benzodiazepines (A) offer amnesia, not analgesia, and increase delirium and hypotension risk. NSAID monotherapy (C) is inadequate and may be contraindicated (bleeding/renal risk). Propofol (D) provides sedation without analgesia and can worsen hypotension. Start a low ketamine infusion after a small bolus if needed; monitor for sialorrhea or psychoperceptual effects (rare at analgesic dosing) and treat with anticholinergic if necessary. Continue multimodal analgesia (acetaminophen, regional techniques at destination) and maintain an explicit pain/sedation target (e.g., CPOT/RASS), reassessing frequently.