Schley M, Topfner S, Wiech K, Schaller H E, Konrad C J, Schmelz M, Birbaumer N
Department of Anaesthesiology and Intensive Care Medicine, Experimental Pain Research/Pain Centre, University of Heidelberg, Faculty of Clinical Medicine, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
Eur J Pain. 2007 Apr;11(3):299-308. doi: 10.1016/j.ejpain.2006.03.003. Epub 2006 May 22.
Hyperexcitability of N-methyl-d-aspartate acid (NMDA) receptors may play an important role in the development of phantom limb pain (PLP).
To investigate whether early treatment with the NMDA antagonist memantine attenuates phantom pain memory formation in traumatic amputees.
In a randomized, double-blind, controlled trial 19 patients with acute traumatic amputation of the upper extremity were investigated. All patients received postoperative analgesia by continuous brachial plexus anesthesia (ropivacaine 0.375% 5 ml/h) for at least 7 days. In addition, the patients received either memantine (20-30 mg daily, n=10) or placebo (n=9) for 4 weeks.
Memantine treatment reduced the number of requested ropivacacine bolus injections during the first week and resulted in a significant decrease of PLP prevalence and intensity at 4 weeks and 6 months follow up, but not at 12 months follow up.
We conclude that memantine can reduce intensity of phantom limb pain and might also prevent the development of PLP. However, despite the very early begin of treatment; no long-term effect on established PLP was evident.
N-甲基-D-天冬氨酸（NMDA）受体的过度兴奋可能在幻肢痛（PLP）的发生发展中起重要作用。
探讨NMDA拮抗剂美金刚早期治疗是否能减轻创伤性截肢患者的幻肢痛记忆形成。
在一项随机、双盲、对照试验中，对19例急性上肢创伤性截肢患者进行了研究。所有患者均通过连续臂丛神经麻醉（0.375%罗哌卡因5 ml/h）进行术后镇痛至少7天。此外，患者接受美金刚（每日20 - 30 mg，n = 10）或安慰剂（n = 9）治疗4周。
美金刚治疗在第一周减少了罗哌卡因推注次数，并在4周和6个月随访时导致PLP患病率和强度显著降低，但在12个月随访时未降低。
我们得出结论，美金刚可减轻幻肢痛强度，也可能预防PLP的发生。然而，尽管治疗开始得非常早，但对已形成的PLP没有明显的长期影响。
