Abstract
Purpose
Ketamine has been administered epidurally and intrathecally for operative and post-operative pain control. Animal studies showed potentiation of analgesia induced by ketamine and morphine. We hypothesized that intrathecal ketamine would potentiate the effects of intrathecal morphine in the treatment of cancer pain.
Methods
A double blind, cross over study was designed to evaluate the effect of ketamine on spinal morphine analgesia in terminal cancer pain patients. A two-phase protocol was used; phase M, intrathecal morphine alone twice daily; phase M+K, co-administration of ketamine (1.0 mg) with morphine intrathecally twice daily. The dose of morphine was titrated upwards until acceptable pain relief was achieved, defined by numeric rating scales (0–10) ≤ 3, and the rescue dose of morphine was less than 5 mg after each intrathecal administration for two days. The dose of intrathecal morphine was defined as the effective dose.
Results
The effective dose of intrathecal morphine in phase M of 0.38 ± 0.04 mg · day−1 was higher than that in phase M+K (0.17 ± 0.02 mg · day−1) (P < 0.05). The average pain scales were 7.95 ± 0.25 before intrathecal drug administration. Pain scales were decreased to 2.2 ± 0.17 (P < 0.05) in phase M and 1.95 ± 0.20 (P < 0.05) in phase M+K after the effective dose of morphine had been reached. No serious side effects were observed in this study.
Conclusion
The present study demonstrates that ketamine enhances the analgesic effect of morphine, thus reducing the dose of intrathecal morphine.
Résumé
Objectif
La kétamine a été administrée par l’approche épidurale et sous-arachnoïdienne pour contrôler la douleur per- et postopératoire. Des études chez l’animal ont révélé que l’analgésie était potentialisée lorsque la kétamine était associée à la morphine. Nous avons vérifié si la ketamine sousarachnoïdienne potentialisait la morphine sous-arachnoïdienne dans le traitement de la douleur du cancer.
Méthodes
Cette étude en double aveugle entrecroisée visait à évaluer l’effet de la kétamine sur la morphine sous-arachnoïdienne administrée à des cancéreux en phase terminale. Un protocole en deux phases a été élaboré pour la voie sousarachnoïdienne: phase M, morphine seule deux fois par jour; phase M+K, association de kétamine (1,0 mg) avec morphine deux fois par jour. La dose de morphine a été augmentée jusqu’à ce qu’un niveau acceptable de soulagement soit atteint, défini sur une échelle numérique (0–10) ≤ 3, et la dose de sauvetage de morphine a été inférieure à 5 mg après chaque administration sous-arachnoïdienne pour deux jours. La dose de morphine était définie comme la dose efficace.
Résultats
En phase M, la dose efficace de morphine sousarachnoïdienne de 0,38 ± 0,04 mg · j−1 a été plus élevée qu’en phase M+K (0,17 ± 0,02 mg · j−1 (P < 0,05). Les échelles d’évaluation de la douleur moyenne étaient de 7,95 ± 0,25 avant l’injection sous-arachnoïdienne. Ces échelles ont baissé à 2,2 ± 0,17 (P < 0,05) en phase M et à 1,95 ± 0,20 (P < 0,05) en phase M+K une fois la dose efficace de morphine atteinte. Il n’y a pas eu d’effets secondaires sérieux.
Conclusion
La présente étude montre que la kétamine augmente l’effet analgésique de la morphine et réduit ainsi la dose de morphine sous-arachnoïdienne.
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Supported in part by National Science Council of R.O.C. (Grant No. NSC 83-0412-B-016-075).
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Yang, CY., Wong, CS., Chang, JY. et al. Intrathecal ketamine reduces morphine requirements in patients with terminal cancer pain. Can J Anaesth 43, 379–383 (1996). https://doi.org/10.1007/BF03011718
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DOI: https://doi.org/10.1007/BF03011718