持续输注氯胺酮治疗截肢后阿片类药物引起的痛觉过敏。
Continuous ketamine infusion for the management of opioid-induced hyperalgesia following amputation.
机构信息
Neurology, The University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada.
Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
出版信息
BMJ Case Rep. 2024 Jan 4;17(1):e255333. doi: 10.1136/bcr-2023-255333.
We discuss the use of an inpatient multi-day continuous intravenous ketamine infusion for the treatment of opioid-induced hyperalgesia (OIH) and high fentanyl requirements in the case of a patient with a background of fibromyalgia/central sensitisation syndrome who underwent a complicated post-operative course following a right below-knee amputation for high-grade myxoid fibrosarcoma. The patient was successfully tapered off a total fentanyl patch dose of 162 mcg/hour every 72 hours (morphine equivalent dose of 389 mg/day) to short-acting hydromorphone 2 mg orally two times per day as needed (equivalent of 8 mg morphine sustained-release twice per day) during a 2-week admission with only mild withdrawal symptoms. We discuss the pharmacology of ketamine and its possible application in the treatment of OIH.
我们讨论了使用住院多日连续静脉注射氯胺酮治疗阿片类药物引起的痛觉过敏（OIH）和高芬太尼需求的情况，该患者患有纤维肌痛/中枢敏化综合征背景，在右小腿截肢术后经历了复杂的术后过程，用于治疗高级黏液样纤维肉瘤。该患者成功地将芬太尼透皮贴剂的总剂量从每 72 小时 162 mcg/h 逐渐减少（相当于每天 389mg 的吗啡等效剂量），在 2 周的住院期间，按需口服氢吗啡酮 2mg，每日两次（相当于每天两次 8mg 吗啡缓释），仅出现轻度戒断症状。我们讨论了氯胺酮的药理学及其在治疗 OIH 中的可能应用。
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