Department of Anesthesiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
CEN Case Rep. 2021 Aug;10(3):422-425. doi: 10.1007/s13730-020-00557-8. Epub 2021 Feb 19.
Calciphylaxis is a small vessel vasculopathy causing subcutaneous ischemic necrosis. This condition is a recognized complication of end stage renal disease and is associated with severe pain. The mechanism of the pain generated by calciphylaxis is thought to be partly related to tissue ischemia, with a significant neuropathic component associated with neuronal hypoxic injury. The pain can be further exacerbated by the inflammatory process ensuing as a result of calciphylactic lesion infections which are commonly associated with this condition. Obtaining adequate pain relief is a challenging aspect of symptom control in calciphylaxis, and historically, patients suffering from calciphylaxis required high dose opioid medications to achieve satisfactory analgesia.This case report presents a multimodal pain management approach utilizing low dose ketamine infusion in an opioid-tolerant patient suffering from severe calciphylaxis-related pain. Ketamine is an anesthetic agent well established for its efficacy in the management of neuropathic pain in opioid-tolerant patients, and has been shown to prevent opioid-induced hyperalgesia and decrease opioid requirements. Prior published data studying pain control in calciphylaxis have mainly focused on subcutaneous ketamine administration which as noted in the literature, can be associated with infusion site complications. To the best of our knowledge, this report is first of its kind to describe successful use of ketamine infusion in treatment of acute calciphylaxis-related pain.Dose modification of ketamine is not required for patients with impaired renal function, and low dose intravenous ketamine infusion was associated with no reported adverse effects in our patient.
钙化防御是一种小血管血管病，导致皮下缺血性坏死。这种情况是终末期肾病的公认并发症，伴有严重疼痛。钙化防御引起的疼痛的机制被认为部分与组织缺血有关，与神经元缺氧损伤相关的显著神经病变成分有关。钙化防御病变感染导致的炎症过程会进一步加重疼痛，这种情况通常与钙化防御有关。获得足够的疼痛缓解是钙化防御症状控制的一个具有挑战性的方面，从历史上看，患有钙化防御的患者需要大剂量阿片类药物来实现令人满意的镇痛效果。本病例报告介绍了一种多模式疼痛管理方法，在一名患有严重钙化防御相关疼痛的阿片类药物耐受患者中使用低剂量氯胺酮输注。氯胺酮是一种麻醉剂，其在治疗阿片类药物耐受患者的神经病理性疼痛方面的有效性已得到充分证实，并且已被证明可预防阿片类药物引起的痛觉过敏和减少阿片类药物的需求。先前发表的研究钙化防御疼痛控制的文献主要集中在皮下给予氯胺酮，如文献所述，这可能与输注部位并发症有关。据我们所知，本报告首次描述了在治疗急性钙化防御相关疼痛中成功使用氯胺酮输注。肾功能受损的患者不需要调整氯胺酮的剂量，我们的患者使用低剂量静脉内氯胺酮输注没有报告不良反应。
