Muller A, Lemos D
Département d'anesthésiologie, hôpitaux universitaire de Strasbourg, hôpital civil, France.
Ann Fr Anesth Reanim. 1996;15(3):271-6. doi: 10.1016/s0750-7658(96)80005-0.
To assess the benefit of ketamine addition to a morphine-clonidine-lidocaine mixture administered continuously by the intrathecal route for the treatment of cancer pain.
Case series analysis.
Four patients experiencing cancer pain with nociceptive and neuropathic components were treated with a continuous intrathecal administration of a mixture of ketamine (10 mg)-morphine (1-20 mg)-clonidine (30 micrograms)-lidocaine (20 mg) in 12 mL of normal saline, injected daily with an infusor (Baxter) pump. This treatment, associated with oral administration of sustained release morphine (SRM), was extended over 35 to 58 days, until the death of the patients.
Either the secondary addition of ketamine to the morphine-clonidine-lidocaine mixture after the 40th and 15th days of treatment in patients no 1 and 2 respectively, because of a loss of efficiency of the mixture, or the immediate administration of the association of the four agents in patients no 3 and 4 provided efficient analgesia, unchanged over time, without significant adverse effects and allowed a decrease of the SRM doses.
Ketamine by intrathecal route potentiates analgesia obtained with morphine-clonidine and lidocaine, while impeding the development of a tolerance vis-à-vis the former.
评估鞘内持续注射氯胺酮联合吗啡-可乐定-利多卡因混合物治疗癌痛的益处。
病例系列分析。
4例伴有伤害性和神经性成分癌痛的患者，接受鞘内持续注射由氯胺酮（10毫克）-吗啡（1 - 20毫克）-可乐定（30微克）-利多卡因（20毫克）溶于12毫升生理盐水中组成的混合物，通过输液泵（百特公司）每日注射。该治疗联合口服缓释吗啡（SRM），持续35至58天，直至患者死亡。
1号和2号患者分别在治疗第40天和第15天后，因混合物疗效丧失而在吗啡-可乐定-利多卡因混合物中追加氯胺酮；3号和4号患者直接使用四种药物联合治疗，均提供了持续有效的镇痛效果，未出现明显不良反应，并允许减少SRM剂量。
鞘内注射氯胺酮可增强吗啡-可乐定和利多卡因的镇痛效果，同时防止对前者产生耐受性。
