Vadivelu Nalini, Schermer Erika, Kodumudi Vijay, Belani Kumar, Urman Richard D, Kaye Alan David
Department of Anesthesiology, School of Medicine, Yale University, New Haven, CT 06520, USA.
Program of Applied Translational Research, Yale University, New Haven, CT 06510, USA.
J Anaesthesiol Clin Pharmacol. 2016 Jul-Sep;32(3):298-306. doi: 10.4103/0970-9185.168149.
Ketamine an N-methyl-D-aspartate (NMDA) receptor blocking agent and a dissociative anesthetic with neurostimulatory side effects. In recent years, multiple research trials as well as systematic reviews and meta-analyses suggest the usefulness of ketamine as a strong analgesic used in subanesthetic intravenous doses, and also as a sedative. In addition, ketamine was noted to possess properties of anti-tolerance, anti-hyperalgesia and anti-allodynia most likely secondary to inhibition of the NMDA receptors. Tolerance, hyperalgesia and allodynia phenomena are the main components of opioid resistance, and pathological pain is often seen in the clinical conditions involving neuropathic pain, opioid-induced hyperalgesia, and central sensitization with allodynia or hyperalgesia. All these conditions are challenging to treat. In low doses, ketamine does not have major adverse dysphoric effects and also has the favorable effects of reduced incidence of opioid-induced nausea and vomiting. Therefore, ketamine can be a useful adjunct for pain control after surgery. Additional studies are required to determine the role of ketamine in the immediate postoperative period after surgical interventions known to produce severe pain and in the prevention and treatment of chronic pain.
氯胺酮是一种N-甲基-D-天冬氨酸（NMDA）受体阻断剂，也是一种具有神经刺激副作用的解离麻醉剂。近年来，多项研究试验以及系统评价和荟萃分析表明，氯胺酮作为一种用于亚麻醉静脉剂量的强效镇痛药以及镇静剂是有用的。此外，氯胺酮被认为具有抗耐受性、抗痛觉过敏和抗异常性疼痛的特性，这很可能是抑制NMDA受体的继发作用。耐受性、痛觉过敏和异常性疼痛现象是阿片类药物耐受的主要组成部分，并且在涉及神经性疼痛、阿片类药物诱导的痛觉过敏以及伴有异常性疼痛或痛觉过敏的中枢敏化的临床情况中经常出现病理性疼痛。所有这些情况的治疗都具有挑战性。低剂量的氯胺酮没有主要的不良烦躁作用，并且还具有降低阿片类药物诱导的恶心和呕吐发生率的有利作用。因此，氯胺酮可以作为术后疼痛控制的有用辅助药物。需要进一步的研究来确定氯胺酮在已知会产生严重疼痛的手术干预后的术后即刻阶段以及慢性疼痛的预防和治疗中的作用。
