Ushida Takahiro, Tani Toshikazu, Kanbara Tetsuya, Zinchuk Vadim S, Kawasaki Motohiro, Yamamoto Hiroshi
Departments of Orthopedic Surgery, Kochi Medical School, Nankoku, Kochi, Japan.
Reg Anesth Pain Med. 2002 Sep-Oct;27(5):524-8. doi: 10.1053/rapm.2002.35517.
Ketamine hydrochloride (KET), an agent used for general anesthesia, has local anesthetic effects and N-methyl-D-aspartate (NMDA) receptor antagonist action. Because recent studies emphasized the role of peripherally distributed NMDA receptors in processing the nociceptive information, we investigated whether peripheral application of the ointment containing KET is able to attenuate the symptoms of local neuropathic pain.
We applied ointment containing KET (0.25%-1.5%) to the affected area on limbs in 5 patients with complex regional pain syndrome type I (CRPS I) and in 2 patients with type II (CRPS II). One to 2 weeks later, we observed improvement of the report of pain intensity, measured by the visual analog scale, in 4 patients with acute early dystrophic stage of CRPS I. Swelling of the affected limbs subsided as well. No apparent changes were noticed in 1 patient with chronic atrophic stage of CRPS I and in both patients with CRPS II.
Topical application of KET appears to be beneficial for the patients with acute early dystrophic stage of CRPS I because of either its local anesthetic effect or NMDA receptor antagonist action. Patients with chronic atrophic stage of CRPS I and CRPS II patients do not appear to respond to this treatment.
盐酸氯胺酮（KET）是一种用于全身麻醉的药物，具有局部麻醉作用和N-甲基-D-天冬氨酸（NMDA）受体拮抗作用。由于最近的研究强调了外周分布的NMDA受体在处理伤害性信息中的作用，我们研究了局部应用含KET的软膏是否能够减轻局部神经性疼痛的症状。
我们将含KET（0.25%-1.5%）的软膏应用于5例Ⅰ型复杂性区域疼痛综合征（CRPS I）患者和2例Ⅱ型（CRPS II）患者的肢体患处。1至2周后，我们观察到4例处于CRPS I急性早期营养不良阶段的患者，其通过视觉模拟量表测量的疼痛强度报告有所改善。患肢肿胀也消退了。1例处于CRPS I慢性萎缩阶段的患者以及2例CRPS II患者均未出现明显变化。
由于KET的局部麻醉作用或NMDA受体拮抗作用，局部应用KET似乎对处于CRPS I急性早期营养不良阶段的患者有益。处于CRPS I慢性萎缩阶段的患者和CRPS II患者似乎对这种治疗无反应。
