TY - JOUR
T1 - Analgesic effect of intravenous ketamine in cancer patients on morphine therapy: A randomized, controlled, double-blind, crossover, double-dose study
AU - Casuccio, Alessandra
AU - Arcuri, Edoardo
AU - Mercadante, Sebastiano
AU - Tirelli, Walter
PY - 2000
Y1 - 2000
N2 - Pain not responsive to morphine is often problematic. Animal and clinical studies have suggested that N-methyl-d-aspartate (NMDA) antagonists, such as ketamine, may be effective in improving opioid analgesia in difficult pain syndromes, such as neuropathic pain. A slow bolus of subhypnotic doses of ketamine (0.25 mg/kg or 0.50 mg/kg) was given to 10 cancer patients whose pain was unrelieved by morphine in a randomized, double-blind, crossover, double-dose study. Pain intensity on a 0 to 10 numerical scale; nausea and vomiting, drowsiness, confusion, and dry mouth, using a scale from 0 to 3 (not at all, slight, a lot, awful); Mini-Mental State Examination (MMSE) (0- 30); and arterial pressure were recorded before administration of drugs (T0) and after 30 minutes (T30), 60 minutes (T60), 120 minutes (T120), and 180 minutes (T180). Ketamine, but not saline solution, significantly reduced the pain intensity in almost all the patients at both doses. This effect was more relevant in patients treated with higher doses. Hallucinations occurred in 4 patients, and an unpleasant sensation ('empty head') was also reported by 2 patients. These episodes reversed after the administration of diazepam 1 mg intravenously. Significant increases in drowsiness were reported in patients treated with ketamine in both groups and were more marked with ketamine 0.50 mg/kg. A significant difference in MMSE was observed at T30 in patients who received 0.50 mg/kg of ketamine. Ketamine can improve morphine analgesia in difficult pain syndromes, such as neuropathic pain. However, the occurrence of central adverse effects should be taken into account, especially when using higher doses. This observation should be tested in studies of prolonged ketamine administration. (C) U.S. Cancer Pain Relief Committee, 2000.
AB - Pain not responsive to morphine is often problematic. Animal and clinical studies have suggested that N-methyl-d-aspartate (NMDA) antagonists, such as ketamine, may be effective in improving opioid analgesia in difficult pain syndromes, such as neuropathic pain. A slow bolus of subhypnotic doses of ketamine (0.25 mg/kg or 0.50 mg/kg) was given to 10 cancer patients whose pain was unrelieved by morphine in a randomized, double-blind, crossover, double-dose study. Pain intensity on a 0 to 10 numerical scale; nausea and vomiting, drowsiness, confusion, and dry mouth, using a scale from 0 to 3 (not at all, slight, a lot, awful); Mini-Mental State Examination (MMSE) (0- 30); and arterial pressure were recorded before administration of drugs (T0) and after 30 minutes (T30), 60 minutes (T60), 120 minutes (T120), and 180 minutes (T180). Ketamine, but not saline solution, significantly reduced the pain intensity in almost all the patients at both doses. This effect was more relevant in patients treated with higher doses. Hallucinations occurred in 4 patients, and an unpleasant sensation ('empty head') was also reported by 2 patients. These episodes reversed after the administration of diazepam 1 mg intravenously. Significant increases in drowsiness were reported in patients treated with ketamine in both groups and were more marked with ketamine 0.50 mg/kg. A significant difference in MMSE was observed at T30 in patients who received 0.50 mg/kg of ketamine. Ketamine can improve morphine analgesia in difficult pain syndromes, such as neuropathic pain. However, the occurrence of central adverse effects should be taken into account, especially when using higher doses. This observation should be tested in studies of prolonged ketamine administration. (C) U.S. Cancer Pain Relief Committee, 2000.
KW - Adverse effects
KW - Anesthesiology and Pain Medicine
KW - Cancer pain
KW - Ketamine
KW - NMDA- antagonist
KW - Neurology (clinical)
KW - Neuropathic pain
KW - Nursing (all)2901 Nursing (miscellaneous)
KW - Opioid response
KW - Randomized controlled epidemiologic study
KW - Adverse effects
KW - Anesthesiology and Pain Medicine
KW - Cancer pain
KW - Ketamine
KW - NMDA- antagonist
KW - Neurology (clinical)
KW - Neuropathic pain
KW - Nursing (all)2901 Nursing (miscellaneous)
KW - Opioid response
KW - Randomized controlled epidemiologic study
UR - http://hdl.handle.net/10447/324083
M3 - Article
VL - 20
SP - 246
EP - 252
JO - Journal of Pain and Symptom Management
JF - Journal of Pain and Symptom Management
SN - 0885-3924
ER -