Subanesthetic ketamine infusion therapy: A retrospective analysis of a novel therapeutic approach to complex regional pain syndrome
Subanesthetic ketamine infusion therapy: A retrospective analysis of a novel therapeutic approach to complex regional pain syndrome
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DOI：
10.1111/j.1526-4637.2004.04043.x
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发表时间：
2004-09-01
期刊：
影响因子：
3.1
通讯作者：
Harbut, RE
中科院分区：
文献类型：
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作者：
Correll, GE;Maleki, J;Harbut, RE
复杂性局部疼痛综合征（CRPS）是一种可能伴有严重疼痛的疾病，通常是慢性的，对常规治疗有抵抗力。Harbut和Correll先前报告了一例9年难治性I型CRPS病例的成功治疗，其中一例成年女性患者接受氯胺酮静脉住院输注[1]。本研究的目的是确定使用氯胺酮亚麻醉住院输注是否确实能有效改善CRPS患者的疼痛评分，从而改善生活质量。为了实现这一目标，我们集中分析了在澳大利亚昆士兰州的Mackay Base医院接受这种新的治疗选择的患者所获得的疼痛缓解。回顾了33例CRPS疼痛患者的病例记录，这些患者通过氯胺酮连续亚麻醉静脉输注住院治疗。记录氯胺酮治疗的剂量和持续时间以及获得的缓解程度和持续时间。还记录了显著的副作用。使用治疗前和治疗后疼痛数值评分评估获得的缓解程度（输注后立即）。使用Kaplan-Meier累积生存曲线分析获得的缓解持续时间（整个随访期间）。共确定了33例至少接受过一次氯胺酮治疗的CRPS诊断患者。由于复发，33名患者中有12名接受了第二个疗程，33名患者中有2名接受了第三个疗程。初始疗程后获得的缓解程度令人印象深刻（N=33）; 25例（76%）患者疼痛完全缓解，6例（18%）患者部分缓解，2例（6%）患者无缓解。重复治疗（N=12）后获得的缓解程度似乎更好，因为接受第二疗程治疗的所有12例患者均完全缓解了CRPS疼痛。缓解的持续时间也令人印象深刻，第一个疗程和第二个疗程后缓解持续时间的差异也令人印象深刻。在这方面，在第一个疗程后，33名患者中有54%的患者在大于或等于3个月的时间内保持无疼痛，31%的患者在大于或等于6个月的时间内保持无疼痛。第二次输注后，12名患者中有58%的患者疼痛缓解时间大于或等于1年，而近33%的患者疼痛缓解时间大于3年。在接受这种治疗的患者中观察到的最常见的副作用是醉酒的感觉。6例患者出现幻觉。较不常见的副作用还包括头晕、头晕和恶心。在4例患者中，观察到肝酶谱的改变;终止输注，此后异常消退。这项回顾性综述表明，有限的亚麻醉住院氯胺酮输注可能为治疗适当选择的难治性CRPS患者提供一种有前途的治疗选择。需要更多的研究来进一步确定这种新方法的安全性和有效性。
Complex Regional Pain Syndrome (CRPS) is a disorder that can be accompanied by severe pain that is often both chronic and resistant to conventional therapy. Harbut and Correll previously reported the successful treatment of a 9-year case of intractable Type I CRPS with an intravenous inpatient infusion of ketamine in an adult female patient [1].Objective. The purpose of this study was to ascertain if indeed the use of subanesthetic inpatient infusions of ketamine provide meaningful improvements in pain scores, and thus, quality of life, in patients suffering from CRPS. To achieve this objective we focused our analysis on the relief of pain obtained by patients undergoing this novel treatment option developed at Mackay Base Hospital, Queensland, Australia.Methods. Case notes of 33 patients whose CRPS pain was treated by the inpatient administration of a continuous subanesthetic intravenous infusion of ketamine were reviewed. The dose and duration of ketamine therapy and the degree and duration of relief obtained were recorded. Notable side effects were also recorded. The degree of relief obtained (immediately after the infusion) was assessed using pre- and posttreatment numeric pain scores. The duration of relief obtained (throughout the follow-up period) was analyzed using a Kaplan-Meier cumulative survival curve analysis.Results. A total of 33 patients with diagnoses of CRPS who had undergone ketamine treatment at least once were identified. Due to relapse, 12 of 33 patients received a second course of therapy, and two of 33 patients received a third. The degree of relief obtained following the initial course of therapy was impressive (N=33); there was complete pain relief in 25 (76%), partial relief in six (18%), and no relief in two (6%) patients. The degree of relief obtained following repeat therapy (N=12) appeared even better, as all 12 patients who received second courses of treatment experienced complete relief of their CRPS pain. The duration of relief was also impressive, as was the difference between the duration of relief obtained after the first and after the second courses of therapy. In this respect, following the first course of therapy, 54% of 33 individuals remained pain free for greater than or equal to3 months and 31% remained pain free for greater than or equal to6 months. After the second infusion, 58% of 12 patients experienced relief for greater than or equal to1 year, while almost 33% remained pain free for >3 years. The most frequent side effect observed in patients receiving this treatment was a feeling of inebriation. Hallucinations occurred in six patients. Less frequent side effects also included complaints of lightheadedness, dizziness, and nausea. In four patients, an alteration in hepatic enzyme profile was noted; the infusion was terminated and the abnormality resolved thereafter.Conclusion. This retrospective review suggests that limited subanesthetic inpatient infusions of ketamine may offer a promising therapeutic option in the treatment of appropriately selected patients with intractable CRPS. More study is needed to further establish the safety and efficacy of this novel approach.