Matsuda W, Matsumura A, Enomoto T, Nose T, Suga A, Miyabe M, Toyooka H
Department of Neurosurgery, Tsukuba University Hospital, Ibaraki-ken, Japan.
No Shinkei Geka. 1999 Feb;27(2):195-200.
We report two cases of refractory pain in a spinal disease. One case was a 60-year-old male who presented intractable pain in bilateral upper extremities after anterior fusion (C5/6, 6/7) for cervical spondylosis. The other was a 63-year-old female who also had intractable pain in the left anterio-lateral chest wall with no remarkable past history. Both cases were refractory to nonsteroidal anti-inflammatory drugs (NSAIDs) or minor tranquilizer or local anesthesia with bupivacaine. However, their pain was significantly relieved by the intravenous administration of a test dose (5mg) of ketamine which is a noncompetitive blocker of N-methyl-D-aspartate (NMDA) receptors. As for case 1, the effect of the injection of the test dose lasted, so continuing infusion therapy of ketamine was cancelled. In case 2, recurrence of the pain was recognized gradually. She underwent continuing infusion therapy of 2mg/kg of ketamine, and it brought about continued pain relief. We conclude that ketamine infusion therapy should also be considered for therapy of refractory neuralgia in spinal disease.
我们报告了两例脊柱疾病中的顽固性疼痛病例。一例为60岁男性，因颈椎病行前路融合术（C5/6、6/7）后出现双侧上肢顽固性疼痛。另一例是63岁女性，既往无明显病史，左侧前胸壁也有顽固性疼痛。两例患者对非甾体类抗炎药（NSAIDs）、小剂量镇静剂或布比卡因局部麻醉均无效。然而，静脉注射5mg试验剂量的氯胺酮（一种N-甲基-D-天冬氨酸（NMDA）受体的非竞争性阻滞剂）后，他们的疼痛明显缓解。对于病例1，试验剂量注射的效果持续存在，因此取消了氯胺酮持续输注治疗。在病例2中，逐渐发现疼痛复发。她接受了2mg/kg氯胺酮的持续输注治疗，疼痛持续缓解。我们得出结论，氯胺酮输注治疗也应被考虑用于脊柱疾病顽固性神经痛的治疗。
