Analgesic effect of intravenous ketamine in cancer patients on morphine therapy: A randomized, controlled, double-blind, crossover, double-dose study
Analgesic effect of intravenous ketamine in cancer patients on morphine therapy: A randomized, controlled, double-blind, crossover, double-dose study
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DOI：
10.1016/s0885-3924(00)00194-9
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发表时间：
2000-10-01
影响因子：
4.7
通讯作者：
Casuccio, A
中科院分区：
文献类型：
--
作者：
Mercadante, S;Arcuri, E;Casuccio, A
对吗啡无反应的疼痛通常是个问题。动物和临床研究表明，N-甲基-D-天冬氨酸 (NMDA) 拮抗剂（如氯胺酮）可能有效改善阿片类药物对困难疼痛综合征（如神经性疼痛）的镇痛作用。在一项随机、双盲交叉试验中，对 10 名癌症患者缓慢推注亚催眠剂量的氯胺酮（0.25 毫克/公斤或 0.50 毫克/公斤），但吗啡仍无法缓解这些患者的疼痛；双剂量研究。疼痛强度按 0 到 10 的数值范围表示；恶心、呕吐、困倦、精神错乱和口干，使用 0 到 3 的等级（完全不、轻微、很多、糟糕）；简易精神状态检查（MMSE）（0-30）；记录给药前(TO)和给药后30分钟(T30)、60分钟(T60)、120分钟(T120)和180分钟(T180)的动脉压。氯胺酮（而非盐水溶液）在两种剂量下均显着降低了几乎所有患者的疼痛强度。这种效应与接受较高剂量治疗的患者更为相关。 4名患者出现幻觉，2名患者还报告有不愉快的感觉（“脑袋空空”）。静脉注射 1 mg 地西泮后，这些症状得以逆转。据报道，两组接受氯胺酮治疗的患者的睡意均显着增加，且接受 0.50 mg/kg 氯胺酮治疗的患者睡意更明显。在接受 0.50 mg/kg 氯胺酮治疗的患者中，在 T30 时观察到 MMSE 湿润度存在显着差异。氯胺酮可以改善吗啡对困难疼痛综合征（例如神经性疼痛）的镇痛作用。然而，应考虑中枢不良反应的发生，特别是在使用较高剂量时。这一观察结果应该在长期服用氯胺酮的研究中进行检验。 (C) 美国癌症疼痛缓解委员会，2000 年。
Pain not responsive to morphine is often problematic Animal and clinical studies have suggested that N-methyl-D-aspartate (NMDA) antagonists, such as ketamine, may be effective in improving opioid analgesia in difficult pain syndromes, such as neuropathic pain. A slow bolus of subhypnotic doses of ketamine (0.25 mg/kg or 0.50 mg/kg) was given to 10 cancer patients whose pain was unrelieved by morphine in a randomized, double-blind crossover; double-dose study. Pain intensity on a 0 to 10 numerical scale; nausea and vomiting drowsiness, confusion, and dry mouth, using a scale from 0 to 3 (not at all, slight, a lot, awful); Mini-Mental State Examination (MMSE) (0-30); and arterial pressure were recorded before administration of drugs (TO) and after 30 minutes (T30), 60 minutes (T60), 120 minutes (T120), and 180 minutes (T180). Ketamine, but not saline solution, significantly reduced the pain intensity in almost all the patients at both doses. This effect was more relevant in patients treated with higher doses. Hallucinations occurred in 4 patients, patients, and an unpleasant sensation ("empty head") was also reported by 2 patients. These episodes reversed after the administration of diazepam 1 mg intravenously. Significant increases in drowsiness were reported in patients treated with ketamine in both groups and were more marked with ketamine 0.50 mg/kg A significant difference in MMSE wets observed at T30 in patients who received 0.50 mg/kg of ketamine. Ketamine can improve morphine analgesia in difficult pain syndromes, such as neuropathic pain. However, the occurrence of central adverse effects should be taken into account, especially when using higher doses. This observation should be tested in studies of prolonged ketamine administration. (C) U.S. Cancer Pain Relief Committee, 2000.