Unité de Traitement de la Douleur de l' Enfant, Centre Leon Berard, Lyon, France.
Pediatric Home Care Unit, Centre Leon Berard, Lyon, France.
BMJ Support Palliat Care. 2022 Nov;12(e5):e656-e663. doi: 10.1136/bmjspcare-2018-001739. Epub 2019 May 31.
Ketamine, an -methyl-D-aspartate receptor antagonist, is effective at relieving adult cancer pain, although there have been very few reports to date regarding its use in children and in adolescents and young adults (AYA). This study assessed the efficacy, safety and opioid-sparing effects of low doses of ketamine added to opioid analgesics to alleviate persistent cancer pain.
This prospective, multicentre, observational trial collected data regarding demographics, pain characteristics, pain score assessment within the first 48 hours of ketamine administration, tolerance and satisfaction from 38 patients aged 2-24 years prescribed with ketamine as an adjuvant antalgic for refractory cancer pain in 10 French paediatric oncology centres.
The mean visual analogue scale pain score decreased from 6.7 to 4.3 out of 10 (n=39, p<0.001) from day 1 to day 3 and by at least 2 points in 56% of the patients (n=22) 48 hours after initiation of ketamine. Nine patients experienced poor tolerance (≥2 side effects), all with infusion rates lower than 0.05 mg/kg/hour. None had limiting toxicities. An opioid-sparing effect was highlighted in four patients. Fifty-four per cent of the prescribers and 47% of the patients found the addition of ketamine 'very helpful'.
Low doses of ketamine as an adjuvant to opioids significantly reduced the intensity of pain in half of the study population. A tendency towards better pain control is shown, although a lack of statistical power somewhat limits our conclusions, especially in children. Nevertheless, ketamine may be a useful option for improving the treatment of refractory pain in children and AYA with cancer.
氯胺酮是一种 N-甲基-D-天冬氨酸受体拮抗剂，在缓解成人癌症疼痛方面有效，尽管迄今为止关于其在儿童和青少年及年轻成人（AYA）中的使用报告非常少。本研究评估了小剂量氯胺酮与阿片类镇痛药联合使用以缓解持续性癌症疼痛的疗效、安全性和阿片类药物节约作用。
这项前瞻性、多中心、观察性试验在法国 10 个儿科肿瘤中心，共纳入了 38 名年龄在 2 至 24 岁的患者，这些患者被开具氯胺酮作为辅助性镇痛药物来治疗难治性癌症疼痛，收集了人口统计学数据、疼痛特征、氯胺酮给药后 48 小时内的疼痛评分评估、耐受性和满意度。
39 例患者中，疼痛视觉模拟评分从第 1 天的 6.7 分降至第 3 天的 4.3 分（n=39，p<0.001），并且在氯胺酮开始使用后 48 小时内，56%（n=22）的患者疼痛评分至少降低了 2 分。9 名患者出现不耐受（≥2 种不良反应），所有患者的输注率均低于 0.05mg/kg/hour。没有患者出现限制毒性。4 名患者出现阿片类药物节约作用。47%的患者和 54%的医生认为添加氯胺酮“非常有帮助”。
小剂量氯胺酮作为阿片类药物的辅助药物可显著降低研究人群中一半患者的疼痛强度。虽然缺乏统计学效力在一定程度上限制了我们的结论，尤其是在儿童中，但疼痛控制得到改善的趋势是明显的。然而，氯胺酮可能是改善儿童和青少年及年轻成人癌症难治性疼痛治疗的一种有用选择。
