Mizuno J, Sugimoto S, Ohmori T, Itadera E, Ichikawa N, Machida K
Department of Anesthesia, Kochi Prefectural Aki Hospital, Aki 784-0027.
Masui. 2001 Jul;50(7):770-2.
We experienced a case of stump pain relieved by continuous intravenous ketamine infusion therapy. A 59-year-old male had his left first through fourth toes amputated because a giant iron plate at work fell on his left foot fifteen years ago. Thereafter he had refractory spontaneous burning pain and night pain on his stump. On examination, we found his left foot skin hard, lustrous, and with sweating disturbance, allodynia and hyperpathia. As intravenous administrations of ketamine 10 mg and thiamylal 50 mg were positive as a drug challenge test, we performed intravenous ketamine infusion at 1 mg.kg-1.hr-1 for 1 hour and a half. After this treatment, his visual analogue scale (VAS) improved dramatically to 0 mm, and night pain, allodynia and hyperpathia disappeared for three days. Thereafter stump pain was relieved to the level of VAS 20 mm. Therefore we diagnosed his stump pain as central pain of neuropathic origin. We suspect that continuous intravenous infusion of ketamine, a noncompetitive blocker of N-methyl-D-aspartic acid receptor, might be an effective and useful alternative treatment in a patient with refractory stump pain.
我们遇到了一例通过持续静脉输注氯胺酮治疗得以缓解的残端痛病例。一名59岁男性因15年前工作时一块巨大铁板砸到他的左脚，导致其左足第一至第四趾被截肢。此后，他的残端出现顽固性自发性灼痛和夜间疼痛。检查时，我们发现他的左脚皮肤坚硬、有光泽，且伴有出汗障碍、痛觉过敏和感觉异常性疼痛。由于静脉注射10毫克氯胺酮和50毫克硫喷妥钠作为药物激发试验呈阳性，我们以1毫克·千克⁻¹·小时⁻¹的速率进行了1个半小时的氯胺酮静脉输注。经过该治疗后，他的视觉模拟评分（VAS）显著改善至0毫米，夜间疼痛、痛觉过敏和感觉异常性疼痛消失了三天。此后，残端痛缓解至VAS 20毫米的水平。因此，我们将他的残端痛诊断为神经性中枢性疼痛。我们怀疑，持续静脉输注氯胺酮这种N-甲基-D-天冬氨酸受体的非竞争性阻滞剂，对于患有顽固性残端痛的患者可能是一种有效且有用的替代治疗方法。
