Culp Clayton, Kim Hee Kee, Abdi Salahadin
McGovern Medical School, University of Texas Health Science Center Houston (UTHealth), Houston, TX, United States.
Division of Anesthesiology, Department of Pain Medicine, Critical Care and Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Front Pharmacol. 2021 Feb 2;11:599721. doi: 10.3389/fphar.2020.599721. eCollection 2020.
Ketamine, an N-methyl-D-aspartate receptor antagonist, is widely known as a dissociative anesthetic and phencyclidine derivative. Due to an undesirable adverse event profile when used as an anesthetic it had widely fallen out of human use in favor of more modern agents. However, it has recently been explored for several other indications such as treatment resistant depression and chronic pain. Several recent studies and case reports compiled here show that ketamine is an effective analgesic in chronic pain conditions including cancer-related neuropathic pain. Of special interest is ketamine's opioid sparing ability by counteracting the central nervous system sensitization seen in opioid induced hyperalgesia. Furthermore, at the sub-anesthetic concentrations used for analgesia ketamine's safety and adverse event profiles are much improved. In this article, we review both the basic science and clinical evidence regarding ketamine's utility in chronic pain conditions as well as potential adverse events.
氯胺酮是一种N-甲基-D-天冬氨酸受体拮抗剂，作为一种分离麻醉剂和苯环己哌啶衍生物而广为人知。由于用作麻醉剂时存在不良的不良事件谱，它已广泛不再用于人类，而更倾向于使用更现代的药物。然而，最近它已被探索用于其他几种适应症，如难治性抑郁症和慢性疼痛。这里汇编的几项近期研究和病例报告表明，氯胺酮在包括癌症相关神经性疼痛在内的慢性疼痛病症中是一种有效的镇痛药。特别值得关注的是氯胺酮通过抵消阿片类药物诱导的痛觉过敏中出现的中枢神经系统敏化而具有的阿片类药物节省能力。此外，在用于镇痛的亚麻醉浓度下，氯胺酮的安全性和不良事件谱有了很大改善。在本文中，我们回顾了关于氯胺酮在慢性疼痛病症中的效用以及潜在不良事件的基础科学和临床证据。
