Lin T C, Wong C S, Chen F C, Lin S Y, Ho S T
Department of Anaesthesiology, Tri-Service General Hospital and National Defence Medical Centre, Taipei, Taiwan, ROC.
Can J Anaesth. 1998 Feb;45(2):175-7. doi: 10.1007/BF03013259.
There is considerable evidence that NMDA receptor antagonists can abolish nociceptor hypersensitivity in animals. In the present case report, two patients with reflex sympathetic dystrophy were treated with ketamine, a NMDA antagonist, morphine and bupivacaine.
Two patients were referred suffering from severe pain, allodynia, hyperaesthesia, swelling and disability over their right lower legs, diagnosed as reflex sympathetic dystrophy. They had received conventional treatments with non-steroid anti-inflammatory drugs (NSAIDs), steroids, anticonvulsant, antidepressant, epidural lidocaine sympathetectomy and rehabilitation which failed to provide satisfactory pain relief. We administered subanalgesic doses of ketamine (7.5 mg), morphine (0.75 mg) and 6 ml bupivacaine 0.1% via a lumbar epidural catheter three times per day. After several courses of treatment over three and six months, satisfactory pain relief was achieved in each patient. Both are now able to walk with slight weight bearing with the assistance of crutch. The treatment is continuing with further improvement of symptoms and signs.
Epidural coadministration of low doses of morphine, ketamine and bupivacaine provided effective pain relief in two patients. This suggests synergy from this combination that provides an alternative treatment for reflex sympathetic dystrophy.
有大量证据表明，N-甲基-D-天冬氨酸（NMDA）受体拮抗剂可消除动物伤害感受器的超敏反应。在本病例报告中，两名反射性交感神经营养不良患者接受了NMDA拮抗剂氯胺酮、吗啡和布比卡因治疗。
两名患者因右小腿严重疼痛、痛觉过敏、感觉异常、肿胀和功能障碍前来就诊，被诊断为反射性交感神经营养不良。他们接受了非甾体抗炎药（NSAIDs）、类固醇、抗惊厥药、抗抑郁药、硬膜外利多卡因交感神经切除术和康复等常规治疗，但未能有效缓解疼痛。我们通过腰椎硬膜外导管，每天3次给予亚镇痛剂量的氯胺酮（7.5毫克）、吗啡（0.75毫克）和6毫升0.1%布比卡因。经过3个月和6个月的几个疗程治疗后，每名患者的疼痛均得到了满意缓解。两人现在都能够在拐杖辅助下轻微负重行走。治疗仍在继续，症状和体征进一步改善。
低剂量吗啡、氯胺酮和布比卡因硬膜外联合给药为两名患者提供了有效的疼痛缓解。这表明这种联合用药具有协同作用，为反射性交感神经营养不良提供了一种替代治疗方法。
