Department of Surgery, Radboud University Nijmegen Medical Centre, The Netherlands.
Reg Anesth Pain Med. 2011 May-Jun;36(3):303-7. doi: 10.1097/AAP.0b013e3182177022.
Upper abdominal pain is a dominant feature of chronic pancreatitis. A key phenomenon in this context is hyperalgesia, typically associated with N-methyl-d-aspartate receptor activation. This exploratory study evaluates acute effects of S-ketamine, a noncompetitive N-methyl-d-aspartate antagonist, in modulating generalized hyperalgesia in chronic pancreatitis pain.
In a blinded crossover trial, 10 chronic pancreatitis pain patients received S-ketamine for 3 hrs at 2 μg · kg · min or placebo infusion at an equivalent rate in randomized order. Clinical pain was assessed via visual analog scale (VAS) and short Dutch Language Version McGill Pain Questionnaire (sf-MPQ-DLV). Pressure pain thresholds (PPTs) were measured in dermatome C5, T4, dorsal T10, L1, and L4, and the sum of PPTs (SOPPT) calculated before, at end of, and after infusion.
Nine patients completed the study. Median pain VAS before infusion was 29 mm at rest, 32 mm during activity; sf-MPQ-DLV score was 4. For the S-ketamine session median SOPPT change at infusion end was significantly higher than in the placebo session (218; interquartile range [IQR], 116-527, versus -123 [IQR, -330 to 24]; P = 0.005) and significant versus preinfusion values (2109 [IQR, 964-3035] vs 1914 [IQR, 842-2884]; P = 0.03). The SOPPT was unchanged versus preinfusion values and similar between groups at 1 hr after infusion end. No significant changes in VAS and sf-MPQ-DLV occurred.
S-ketamine infusion is more effective than placebo in increasing PPTs in chronic pancreatitis pain patients immediately after infusion. This effect did not outlast the infusion. Further research is warranted into S-ketamine use for reducing generalized hyperalgesia and chronic pancreatitis pain.
上腹痛是慢性胰腺炎的主要特征。在此背景下的一个关键现象是痛觉过敏，通常与 N-甲基-D-天冬氨酸受体激活有关。本探索性研究评估了 S-氯胺酮（一种非竞争性 N-甲基-D-天冬氨酸拮抗剂）对慢性胰腺炎疼痛的全身性痛觉过敏的急性影响。
在一项双盲交叉试验中，10 名慢性胰腺炎疼痛患者以 2μg·kg·min 的速率接受 S-氯胺酮输注 3 小时或接受等效速率的安慰剂输注，随机顺序进行。通过视觉模拟评分（VAS）和简短荷兰语版 McGill 疼痛问卷（sf-MPQ-DLV）评估临床疼痛。在 C5、T4、T10 背侧、L1 和 L4 皮节测量压力疼痛阈值（PPT），并在输注前、输注结束时和输注后计算 PPT 总和（SOPPT）。
9 名患者完成了研究。输注前静息时疼痛 VAS 中位数为 29mm，活动时为 32mm；sf-MPQ-DLV 评分为 4 分。S-氯胺酮治疗组输注结束时 SOPPT 变化的中位数明显高于安慰剂组（218[IQR，116-527，与-123[IQR，-330 至 24]；P=0.005），与输注前相比也有显著差异（2109[IQR，964-3035]与 1914[IQR，842-2884]；P=0.03）。输注结束后 1 小时，SOPPT 与输注前相比无明显变化，两组间也无明显差异。VAS 和 sf-MPQ-DLV 无显著变化。
与安慰剂相比，S-氯胺酮输注在输注后立即增加慢性胰腺炎疼痛患者的 PPT 更有效。这种效果在输注结束后并未持续。需要进一步研究 S-氯胺酮在减少慢性胰腺炎疼痛的全身性痛觉过敏中的作用。
