Visser E, Schug S A
Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, and University of Western Australia, School of Medicine and Pharmacology, Perth, WA 6847, Australia.
Biomed Pharmacother. 2006 Aug;60(7):341-8. doi: 10.1016/j.biopha.2006.06.021. Epub 2006 Jul 5.
Ketamine is a dissociative anaesthetic; its mechanism of action is primarily an antagonism of the N-methyl-D-aspartate (NMDA) receptor. The role of ketamine, in particular in lower sub-anaesthetic doses, has recently gained increasing interest in pain management. It has been studied in a considerable number of trials and analysed in meta-analyses and systematic reviews. Based on these data, the primary role of ketamine in such low doses is as an 'anti-hyperalgesic', 'anti-allodynic' or 'tolerance-protective' agent. It therefore has a role in the treatment of opioid resistant or 'pathological' pain (central sensitisation with hyperalgesia or allodynia, opioid induced hyperalgesia, neuropathic pain) rather than as an 'analgesic' in its own right. Low dose ketamine also has 'preventive analgesia' properties. Furthermore, in higher doses it provides effective and safe sedation and analgesia for painful procedures. The place of ketamine in the treatment of chronic pain and the effects of long-term medicinal use remain unclear.
氯胺酮是一种解离性麻醉剂；其作用机制主要是对N-甲基-D-天冬氨酸（NMDA）受体的拮抗作用。氯胺酮的作用，尤其是在低于麻醉剂量时，最近在疼痛管理方面越来越受到关注。它已经在大量试验中得到研究，并在荟萃分析和系统评价中进行了分析。基于这些数据，低剂量氯胺酮的主要作用是作为一种“抗痛觉过敏”、“抗异常性疼痛”或“耐受性保护”药物。因此，它在治疗阿片类药物抵抗性或“病理性”疼痛（伴有痛觉过敏或异常性疼痛的中枢敏化、阿片类药物诱导的痛觉过敏、神经性疼痛）中发挥作用，而不是本身作为一种“镇痛药”。低剂量氯胺酮还具有“预防性镇痛”特性。此外，在较高剂量时，它为疼痛性操作提供有效且安全的镇静和镇痛作用。氯胺酮在慢性疼痛治疗中的地位以及长期药用的效果仍不明确。
