Ketamine, an N-methyl-D-aspartate antagonist, is an anesthetic used for general anesthesia. In the past 20 years, ketamine has been successfully formulated topically and has been used for analgesia. Topical analgesics are popular among physicians due to their efficacy and limited systemic effects. With the rise in compounding pharmacies in the U.S., the use of topical ketamine compounded with various bases and other analgesics has been increasing. There are numerous small studies examining the efficacy and safety of topical ketamine mainly on neuropathic pain. In this article, a narrative review examining topical ketamine's mechanism, pharmacology, use, safety, and future will be analyzed.