Laufer M, Schippel P, Wild L, Olthoff D
Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universität Leipzig.
Schmerz. 2005 Jun;19(3):220-4. doi: 10.1007/s00482-004-0323-5.
We are reporting on the case of an 11-year old girl with a malignant tumour. The extreme pain throughout the body could not be treated by conventional methods. By intravenous application of a morphine and s-ketamine mixture we were able to achieve a very effective analgesic result. Apart from the opiate effect of the morphine the decisive factor was the NMDA-antagonism of the s-ketamine. The latter suppresses central sensitisation and chronic pain and reduces or even prevents the development of opioid tolerance. It was possible to use smaller opiate doses more effectively, thus reducing the side effects of the pain therapy. Under associated whole-body thermochemotherapy the girl experienced general pain relief and we were able to return to conventional therapy with a fentanyl plaster.
我们报告了一名患有恶性肿瘤的11岁女孩的病例。全身的剧痛无法通过传统方法治疗。通过静脉注射吗啡和S-氯胺酮混合物，我们能够取得非常有效的镇痛效果。除了吗啡的阿片样作用外，决定性因素是S-氯胺酮的NMDA拮抗作用。后者可抑制中枢敏化和慢性疼痛，并减少甚至防止阿片类药物耐受性的发展。可以更有效地使用较小剂量的阿片类药物，从而减少疼痛治疗的副作用。在联合全身热化疗的情况下，女孩的全身疼痛得到缓解，我们能够改用芬太尼透皮贴剂进行常规治疗。
