Ketamine in Context of Oncologic Palliative Care: A Challenge Experience of a Palliative Care Service
DOI:
https://doi.org/10.24950/O/280/19/1/2020Keywords:
Ketamine, Pain Management, Palliative CareAbstract
Introduction: Ketamine is a dissociative anaesthetic agent which has analgesic and antidepressants properties in suban- aesthetic doses, and it has been used as an adjuvant treatment for opioid-refractory cancer pain.
The aim of this study was to assess the use of ketamine in a palliative care centre.
Material and Methods: Retrospective study for thirty months in an oncologic adult palliative care service of patients undergoing treatment with ketamine.
Results/Discussion: Twenty patients were analysed. Ages varied from 26 to 78 years, median of 54.5. Ketamine was used as an adjuvant treatment for opioid-refractory cancer pain in 18 patients, and in two to treat depression. In the first group all patients had unbearable pain and 22% showed signs of opioids adverse effects; 73% had mixed pain. They were treated with high doses of opioids-equivalent to a median dose of 422.5 mg/ day of oral morphine. The average dose of ketamine was 85 mg/ day, median 80 mg/day, in continuous intravenous or subcutaneous infusion in 90% of them. The dose of opioid decreased in 12% and the rescue opioid dose in 53%. In 70% the pain was relieved. Improvement in pain was found in an average of 4.8 days. All received neuroleptics with or without benzodiazepines. The psychotomimetic side effects in one patient forced to discontinue ketamine. Patients with depression demonstrated an improve- ment in mood as the main response to a single dose of ketamine.
Conclusion: The results of this study showed ketamine efficiency in subanaesthetic doses to help control the cancer pain. Despite being a promising therapeutic approach in palliative care units more research must be carried out to define the role of ketamine in Palliative Care.
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References
Persson J. Ketamine in pain management. CNS Neurosci Ther. 2013;19:396-402.
Mion G, Villevieille T. Ketamine pharmacology: an update (pharmacodynamics and molecular aspects, recentfindings). CNS Neurosci Ther. 2013;19:370-80.
Sleigh J, Martyn H, Voss L, Denny B. Ketamine - more mechanisms of action than just NMDA blockade. Trends Anaesth Critical Care. 2014;4:76-81.
Subramaniam K, Subramaniam B, Steinbrook RA. Ketamine as adjuvant analgesic to opioids: a quantitative and qualitative systematic review. Anesth Analg. 2004;99: 482-95.
Bell RF, Dahl JB, Moore RA, Kalso E. Perioperative ketamine for acute postoperative pain. Cochrane Database Syst Rev. 2006;1:CD004603.
Bell RF. Ketamine for chronic non-cancer pain. Pain. 2009;141:210-14. 7. Zgaia AO, Irimie A, Sandesc D, Vlad C, Lisencu C, Rogobete A, etal.The role of ketamine in the treatment of chronic cancer pain. Clujul Med. 2015;88:457-61. doi: 10.15386/cjmed-500.
Quibell R, Fallon M, Mihalyo M, Twycross R, Wilcock A. Ketamine. J Pain Symptom Manage. 2015;50:268-78. doi: 10.1016/j.jpainsym-man.2015.06.002.
Bell RF, Eccleston C, Kalso EA. Ketamine as an adjuvant to opioids for cancer pain. Cochrane Database Syst Rev. 2017;6:CD003351. doi: 10.1002/14651858.CD003351.pub3.
Zanos,P. Moaddel R, Morris PJ, Georgiou P, Fischell J, Elmer GI, et al. NMDAR inibition-independent antidepressant actions of ketamine metabolites. Nature.2016; 533:481–6. doi: 10.1038/nature17998.
Zarate CA Jr, Singh JB, Carlson PJ, Brutsche NE, Ameli R, Luckenbau- gh DA, Charney DS, Manji HK. A randomized trial of an N-methyl-D- -aspartate antagonist in treatment-resistant major depression. Arch Gen Psychiatry. 2006;63:856-64.
Berman RM. Antidepressant effects of ketamine in depressed patients. Biol Psychiatry. 2000;47: 351–4.
Abdallah CG, Sanacora G, Duman RS, Krystal JH. Ketamine and rapid-acting antidepressants: a window into a new neurobiology for mood disorder therapeutics.Annu Rev Med. 2015;66:509-23. doi: 10.1146/ annurev-med-053013-062946.
Cetamina. [consultado setembro 2017] Disponível em: http://www.ipan. med.br/cetamina
Fitzgibbon EJ, Hall P, Schroder C, Seely J, Viola R. Low dose ketami- ne as an analgesic adjuvant in difficult pain syndromes: a strategy for conversion from parenteral to oral ketamine. J Pain Symptom Manage. 2002;23:165-70.
Mercadante S. ketamine in cancer pain: an update. PalliatMed. 1996; 10: 225-230
Mercadante S. ketamine: to be or not to be. Ann Palliat Med. 2013; 2:37- 9
Quibell R, Fallon M, Mihalyo M, Twycross R, Wilcock A. Ketamine. J Pain Symptom Manage. 2015;50:268-78. doi: 10.1016/j.jpainsym- man.2015.06.002.
Bell RF. Ketamine for chronic non-cancer pain. Pain. 2009;141:210-4. doi: 10.1016/j.pain.2008.12.003.
Alviar MJ, Hale T, Dungca M. Pharmacologic interventions for treating phantom limb pain. Cochrane Database Syst Rev. 2016;10:CD006380.
Sigtermans MJ, van Hilten JJ, Bauer MC, Arbous MS, Marinus J, Sarton EY, et al. Ketamine produces effective and long-term pain relief in patients with Complex Regional Pain Syndrome Type 1. Pain. 2009;145:304-11. doi: 10.1016/j.pain.2009.06.023.
Niesters M, Martini C, Dahan A. ketamine for chronic pain: risks and be- nefits. Br J Clin Pharmacol. 2013; 77:357-67. doi: 10.1111/bcp.12094.
Mercadante S, Arcuri E., Tirelli W, Casuccio A. Analgesic effect of intravenous ketamine in cancer patients on morphine therapy: a randomized, controlled, double-blind, crossover, double-dose study. J Pain Symptom Manage. 2000; 20:246-52.
Yang CY, Wong CS, Chang JY, Ho ST. Intrathecal ketamine reduces mor- phine requirements in patients with terminal cancer pain. Can J Anaesth. 1996; 43: 379-83.
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