Simões Carolina, Julião Miguel, Calaveiras Patrícia, Câmara Paula, Santos Teresa
Department of Palliative Medicine, Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra, ULS Amadora/Sintra, Sintra, Portugal.
Department of Palliative Medicine, Unidade de Cuidados na Comunidade de Vila Franca de Xira, ULS Estuário do Tejo, Vila Franca de Xira, Portugal.
Palliat Support Care. 2024 Oct;22(5):1516-1520. doi: 10.1017/S1478951524000798.
Ketamine has been widely used in refractory pain as an opioid adjuvant. Evidence suggests that ketamine can also have an essential role in easing depressive symptoms. Its rapid onset of action makes it a valuable choice in palliative care.
We present a case of a 70-year-old man with stage IV renal carcinoma and bone metastasis. The main symptoms included neuropathic pain, depression, and a persistent and severe desire for death.
We started continuous subcutaneous infusion with morphine 30 mg and ketamine 100 mg/day. The dose of ketamine was incremented to the maximum of 250 mg/day. During the 28-day treatment, we observed an overall improvement in neuropathic pain, depressive symptoms, and other end-of-life psychological aspects of distress. Only minor psychological side effects were identified, which were controlled by using midazolam in the continuous subcutaneous infusion.
Some studies have already demonstrated the benefits of ketamine use in alleviating depression, using parental infusion or oral formulas, which are administered in hospice care. Our report enhances the benefit of the subcutaneous route for palliative patients cared for at home.
氯胺酮已作为阿片类药物辅助剂广泛用于难治性疼痛。有证据表明，氯胺酮在缓解抑郁症状方面也可发挥重要作用。其起效迅速，使其成为姑息治疗中有价值的选择。
我们报告一例70岁男性患者，患有IV期肾癌并伴有骨转移。主要症状包括神经性疼痛、抑郁以及持续且强烈的求死欲望。
我们开始持续皮下输注吗啡30毫克和氯胺酮100毫克/天。氯胺酮剂量逐渐增加至最大250毫克/天。在28天的治疗期间，我们观察到神经性疼痛、抑郁症状以及其他临终心理困扰方面总体有所改善。仅发现轻微的心理副作用，通过在持续皮下输注中使用咪达唑仑得以控制。
一些研究已经证明，在临终关怀中使用静脉输注或口服制剂的氯胺酮在缓解抑郁方面具有益处。我们的报告进一步证明了皮下给药途径对居家接受姑息治疗患者的益处。
