Dulin Jennifer D, Hardcopf Jennifer, Coyne Patrick J
Division of General Internal Medicine and Geriatrics, Department of Medicine, Palliative Medicine and General Internal Medicine at the Medical University of South Carolina, Charleston, South Carolina, USA.
Department of Clinical Pharmacy Services, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
J Palliat Med. 2021 Jan;24(1):148-151. doi: 10.1089/jpm.2020.0027. Epub 2020 Mar 25.
Optimal pain management in the palliative care setting often requires multiple pharmacological interventions including novel and off-label therapies. Ketamine is an anesthetic agent with increasing evidence supporting its use for pain. Through -methyl-d-aspartate antagonism and activity at opioid receptors, it is an adjuvant to traditional analgesics with the benefit of being opioid sparing. Ketamine has a wide safety profile with limited reports of overdose. Little is published on supratherpeutic dosing in the pain setting. We report a case of a 41-year-old male with refractory nociceptive and neuropathic cancer-related pain. Conventional therapies were ineffective. Ketamine was initiated to reduce opioid burden and attenuate pain with good response. The patient received an iatrogenic overdose (10 times ordered dose) of the drug. Several self-limited physiologic and psychologic reactions were observed during subsequent monitoring. This is a study and analysis of a patient with refractory nociceptive and neuropathic pain syndrome treated with ketamine who sustained an iatrogenic overdose of ketamine. Ketamine's use to treat pain is increasing along with its evidence of efficacy. Despite ketamine's wide safety profile, the medication is not without risk, especially in palliative care wherein patients are on multiple drugs with potentially severe interactions. Careful examination of the risks of overdose, especially of the various formulations of the drug, is needed.
姑息治疗环境中的最佳疼痛管理通常需要多种药物干预，包括新型和超说明书疗法。氯胺酮是一种麻醉剂，越来越多的证据支持其用于疼痛治疗。通过拮抗N-甲基-D-天冬氨酸以及作用于阿片受体，它可作为传统镇痛药的辅助药物，具有减少阿片类药物用量的益处。氯胺酮具有广泛的安全性，过量用药报告有限。关于疼痛治疗中超治疗剂量的报道很少。我们报告一例41岁男性患者，患有难治性伤害性和神经性癌症相关疼痛。传统疗法无效。开始使用氯胺酮以减轻阿片类药物负担并减轻疼痛，效果良好。该患者接受了该药物的医源性过量用药（为医嘱剂量的10倍）。在随后的监测中观察到了几种自限性生理和心理反应。这是一项对一名难治性伤害性和神经性疼痛综合征患者使用氯胺酮治疗且发生氯胺酮医源性过量用药的研究与分析。随着氯胺酮治疗疼痛有效性证据的增加，其使用也在增多。尽管氯胺酮具有广泛的安全性，但该药物并非没有风险，尤其是在姑息治疗中，患者正在使用多种药物，可能存在严重相互作用。需要仔细研究过量用药的风险，尤其是该药物的各种剂型。
