Jiao Jiao, Fan Jin, Zhang Yonggang, Chen Lingmin
Department of Anesthesiology (J.J., L.C.), West China Hospital, Sichuan University, Chengdu, China; The Research Units of West China-Chinese Academy of Medical Sciences (J.J., L.C.), West China Hospital, Sichuan University, Chengdu, China.
School of Acupuncture-Moxibustion and Tuina (J.F.), Chengdu University of Traditional Chinese Medicine, Chengdu, China.
J Pain Symptom Manage. 2024 Mar;67(3):e185-e210. doi: 10.1016/j.jpainsymman.2023.11.004. Epub 2023 Nov 14.
Ketamine is a well-characterized anesthetic agent, and subanesthetic ketamine possesses analgesic effects in both acute and chronic pain.
A systematic review was performed to ascertain the efficacy and safety of ketamine in treating pain for cancer patients.
Eight databases were searched from the inception to March 20th, 2023 to obtain randomized controlled trials (RCTs) on ketamine for treating pain in cancer patients. Two reviewers independently screened studies, extracted the data and assessed the risk of bias of included studies; then, meta-analysis was performed by using Revman 5.3 software and Stata 14.0 software.
Thirty-five studies were included, involving 2279 patients with cancer pain. The results of meta-analysis showed that ketamine could significantly reduce pain intensity. Subgroup analysis revealed that, when compared with control group, ketamine decreased markedly visual analogue scale (VAS) scores in two days after the end of treatment with ketamine, and ketamine administrated by patient controlled epidural analgesia (PCEA) was effective. Meanwhile, ketamine could significantly reduce the number of patient-controlled analgesia (PCA) compressions within 24 hours and morphine dosage. Ketamine could not decrease Ramsay sedation score. Additionally, the adverse events significantly decreased in the ketamine group, including nausea and vomiting, constipation, pruritus, lethargy, uroschesis, hallucination, and respiratory depression. In addition, compared with the control group, ketamine could reduce Hamilton depression scale (HAMD) score and relieve depressive symptoms.
Ketamine may be used as an effective therapy to relieve cancer pain. However, more rigorously designed RCTs with larger sample sizes are required to verify the above conclusions.
氯胺酮是一种特征明确的麻醉剂，亚麻醉剂量的氯胺酮在急性和慢性疼痛中均具有镇痛作用。
进行一项系统评价，以确定氯胺酮治疗癌症患者疼痛的疗效和安全性。
检索了8个数据库，检索时间从建库至2023年3月20日，以获取关于氯胺酮治疗癌症患者疼痛的随机对照试验（RCT）。两名研究者独立筛选研究、提取数据并评估纳入研究的偏倚风险；然后，使用Revman 5.3软件和Stata 14.0软件进行荟萃分析。
纳入35项研究，涉及2279例癌症疼痛患者。荟萃分析结果显示，氯胺酮可显著降低疼痛强度。亚组分析显示，与对照组相比，氯胺酮治疗结束后两天内视觉模拟量表（VAS）评分显著降低，且患者自控硬膜外镇痛（PCEA）使用氯胺酮有效。同时，氯胺酮可显著减少24小时内患者自控镇痛（PCA）按压次数和吗啡用量。氯胺酮不会降低Ramsay镇静评分。此外，氯胺酮组的不良事件显著减少，包括恶心、呕吐、便秘、瘙痒、嗜睡、尿潴留、幻觉和呼吸抑制。此外，与对照组相比，氯胺酮可降低汉密尔顿抑郁量表（HAMD）评分并缓解抑郁症状。
氯胺酮可作为缓解癌症疼痛的有效治疗方法。然而，需要更严格设计、更大样本量的RCT来验证上述结论。
