Zgaia Armeana Olimpia, Irimie Alexandru, Sandesc Dorel, Vlad Catalin, Lisencu Cosmin, Rogobete Alexandru, Achimas-Cadariu Patriciu
Department of Oncological Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Department of Anesthesia and Critical Care, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
Clujul Med. 2015;88(4):457-61. doi: 10.15386/cjmed-500. Epub 2015 Nov 15.
Ketamine is a drug used for the induction and maintenance of general anesthesia, for the treatment of postoperative and posttraumatic acute pain, and more recently, for the reduction of postoperative opioid requirements. The main mechanism of action of ketamine is the antagonization of N-methyl-D-aspartate (NMDA) receptors that are associated with central sensitization. In the pathogenesis of chronic pain and particularly in neuropathic pain, an important role is played by the activation of NMDA receptors. Although ketamine is indicated and used for the treatment of chronic cancer pain as an adjuvant to opioids, there are few clinical studies that clearly demonstrate the effectiveness of ketamine in this type of pain. The aim of this study is to analyze evidence-based clinical data on the effectiveness and safety of ketamine administration in the treatment of chronic neoplastic pain, and to summarize the evidence-based recommendations for the use of ketamine in the treatment of chronic cancer pain.
We reviewed the literature from the electronic databases of MEDLINE, COCHRANE, PUBMED, MEDSCAPE (1998-2014), as well as chapters of specialized books (palliative care, pain management, anesthesia).
A number of studies support the effectiveness of ketamine in the treatment of chronic cancer pain, one study does not evidence clear clinical benefits for the use of ketamine, and some studies included too few patients to be conclusive.
Ketamine represents an option for neoplasic pain that no longer responds to conventional opioid treatment, but this drug should be used with caution, and the development of potential side effects should be carefully monitored.
氯胺酮是一种用于诱导和维持全身麻醉、治疗术后及创伤后急性疼痛的药物，最近还用于减少术后阿片类药物的用量。氯胺酮的主要作用机制是拮抗与中枢敏化相关的N-甲基-D-天冬氨酸（NMDA）受体。在慢性疼痛尤其是神经性疼痛的发病机制中，NMDA受体的激活起着重要作用。尽管氯胺酮被推荐并用于治疗慢性癌痛作为阿片类药物的辅助用药，但很少有临床研究能明确证明氯胺酮在这类疼痛治疗中的有效性。本研究的目的是分析氯胺酮治疗慢性肿瘤疼痛有效性和安全性的循证临床数据，并总结氯胺酮治疗慢性癌痛的循证推荐意见。
我们检索了MEDLINE、COCHRANE、PUBMED、MEDSCAPE（1998 - 2014年）电子数据库的文献，以及专业书籍（姑息治疗、疼痛管理、麻醉学）的章节。
多项研究支持氯胺酮治疗慢性癌痛的有效性，一项研究未证明使用氯胺酮有明确的临床益处，一些研究纳入的患者过少无法得出结论。
氯胺酮是对传统阿片类治疗不再有效的肿瘤疼痛的一种选择，但该药应谨慎使用，并应密切监测潜在副作用的发生。
