Anesthesia Department, Tanta University Hospital, Tanta, Egypt.
Pain Physician. 2010 May-Jun;13(3):245-9.
Severe, intractable, chronic pain is a significant management problem for those involved in the long-term care of spinal cord injury (SCI) patients . Gabapentin, an anticonvulsant, is widely used for treating chronic pain. Ketamine, an NMDA receptor antagonist, has been available in clinical practice for 35 years. Its usefulness in pathological pain states is known. Despite this, no formal research on its effectiveness in treating neuropathic SCI pain exists.
This double-blind study sought to determine the safety and efficacy of adding a multi-day low dose ketamine infusion to oral gabapentin for treating chronic pain related to post spinal cord injury.
Randomized, controlled, double blind trial.
Hospital, in-patient setting.
Forty patients diagnosed with neuropathic pain secondary to spinal cord injury were randomized into 2 equal groups. Group I received an 80 mg intravenous ketamine infusion diluted in 500 cc normal saline over a 5 hour period daily for one week and 300 mg of gabapentin 3 times daily. Group II received a placebo infusion and 300 mg of gabapentin 3 times daily (continued) after 300 mg of gabapentin 3 times daily. Using the visual analogue scale, pain was assessed prior to treatment, daily following ketamine or placebo infusions for 7 days, and then weekly for one month after infusion termination. Side effects, specifically those related to ketamine or gabapentin, were reported.
Both groups demonstrated significantly reduced pain scores compared with pre-treatment values (P < 0.05). Group I showed significant pain score improvements over Group II at all measurements (P < 0.0001) during infusion and 2 weeks after infusion termination. There was no statistical difference between the groups at 3 weeks and 4 weeks after infusion termination (P = 0.54 and P = 0.25 respectively). Both drugs were tolerated by all patients; no side effects required intervention.
Multi-day low dose ketamine infusion as adjuvant to gabapentin in post-spinal cord injury related chronic pain is safe and efficacious in reducing pain, but the effect compared to placebo ceased 2 weeks after infusion termination.
Study size limited to 40 patients.
严重、难治、慢性疼痛是长期护理脊髓损伤（SCI）患者的重大管理问题。加巴喷丁是一种抗惊厥药，广泛用于治疗慢性疼痛。氯胺酮是一种 NMDA 受体拮抗剂，已在临床实践中使用了 35 年。它在病理性疼痛状态中的有效性是已知的。尽管如此，尚无关于其治疗神经性 SCI 疼痛的有效性的正式研究。
本双盲研究旨在确定每日多次低剂量氯胺酮输注联合口服加巴喷丁治疗脊髓损伤后相关慢性疼痛的安全性和有效性。
随机、对照、双盲试验。
医院，住院环境。
40 名诊断为神经性疼痛继发于脊髓损伤的患者被随机分为 2 组，每组 20 名。第 I 组接受 80mg 静脉氯胺酮输注，用 500cc 生理盐水稀释，每天输注 5 小时，持续 1 周，每日 3 次给予 300mg 加巴喷丁。第 II 组接受安慰剂输注，300mg 加巴喷丁 3 次/天（继续），300mg 加巴喷丁 3 次/天后。使用视觉模拟评分法，在治疗前、氯胺酮或安慰剂输注后每天评估疼痛，输注结束后每周评估 1 个月。报告了副作用，特别是与氯胺酮或加巴喷丁相关的副作用。
两组患者的疼痛评分均较治疗前显著降低（P<0.05）。在输注期间和输注结束后 2 周，第 I 组的疼痛评分改善明显优于第 II 组（P<0.0001）。输注结束后 3 周和 4 周时，两组之间无统计学差异（P=0.54 和 P=0.25）。所有患者均耐受两种药物；无副作用需要干预。
多日低剂量氯胺酮输注作为脊髓损伤后相关慢性疼痛的辅助治疗加巴喷丁是安全有效的，可降低疼痛，但与安慰剂相比，输注结束后 2 周疼痛缓解效果停止。
研究规模限于 40 名患者。
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