Winstead Madison C, Wells Kimberly J, Howington Gavin T
University of Kentucky College of Pharmacy, Lexington, Kentucky.
University of Kentucky HealthCare, Department of Emergency Medicine, Lexington, Kentucky.
Clin Pract Cases Emerg Med. 2023 May;7(2):93-96. doi: 10.5811/cpcem.1405.
Phantom limb pain (PLP) is a poorly understood phenomenon experienced by amputees. The pain is typically classified as neuropathic, and there is no established first-line therapy. Droperidol is an antipsychotic with a wide array of pharmacologic activity including gamma-aminobutyric acid-A channel modulation, μ opioid receptor potentiation, dopamine-2-receptor blockade, and alpha-2-receptor agonism. Due to this broad therapeutic activity, droperidol is used for many off-label indications.
Our patient was a 25-year-old male with a history of lower limb amputation who presented for evaluation and management of an acute exacerbation of PLP. On arrival, the patient was in 10/10 pain (numeric pain rating scale) described as cramping and burning. He had been previously successfully managed with subdissociative ketamine. However, during a recent exacerbation he experienced an emergence reaction to ketamine. Literature guiding pharmacotherapy in the management of PLP is sparse and of low quality. Based on the prior emergence reaction to subdissociative ketamine we explored other pharmacotherapy options. Droperidol has a wide array of pharmacologic activity and is used off label for the management of some pain syndromes. Therefore, we administered an intravenous dose of droperidol 5 milligrams. Approximately 15 minutes after receiving droperidol the patient's pain was visibly improved, and 30 minutes later he rated his pain at 3/10.
The success in treating this patient provides encouragement for future research and bolsters confidence that droperidol could be another tool in the management of complex pain syndromes.
幻肢痛（PLP）是截肢者经历的一种难以理解的现象。这种疼痛通常被归类为神经性疼痛，且尚无既定的一线治疗方法。氟哌利多是一种具有广泛药理活性的抗精神病药物，包括γ-氨基丁酸-A通道调节、μ阿片受体增强、多巴胺-2受体阻断和α-2受体激动作用。由于这种广泛的治疗活性，氟哌利多被用于许多非标签适应症。
我们的患者是一名25岁男性，有下肢截肢史，因幻肢痛急性加重前来评估和治疗。入院时，患者疼痛评分为10分（数字疼痛评分量表），描述为痉挛性和烧灼样疼痛。他之前使用亚解离剂量的氯胺酮治疗成功。然而，在最近一次病情加重期间，他对氯胺酮出现了不良反应。指导幻肢痛药物治疗的文献稀少且质量不高。基于之前对亚解离剂量氯胺酮的不良反应，我们探索了其他药物治疗选择。氟哌利多具有广泛的药理活性，可用于非标签治疗某些疼痛综合征。因此，我们静脉注射了5毫克氟哌利多。在接受氟哌利多后约15分钟，患者的疼痛明显改善，30分钟后他将疼痛评分降至3分。
该患者治疗成功为未来研究提供了鼓励，并增强了信心，即氟哌利多可能是治疗复杂疼痛综合征的另一种工具。
