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Treatment of neuropathic cancer pain with continuous intrathecal administration of S (+)‐ketamine
Author(s) -
Vranken J. H.,
Van Der Vegt M. H.,
Kal J. E.,
Kruis M. R.
Publication year - 2004
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.0001-5172.2004.00284.x
Subject(s) - medicine , ketamine , anesthesia , clonidine , neuropathic pain , morphine , cancer pain , opioid , dextromethorphan , cancer , receptor
The effective treatment of patients suffering from neuropathic cancer pain remains a clinical challenge. When patients experience either insufficient analgesia or problematic side‐effects after opioid administration, intrathecal administration of morphine and other medications such as bupivacaine and clonidine may offer significant advantages. Additionally, ketamine, a non‐competitive N ‐methyl‐ d ‐Aspartate‐receptor antagonist is able to alter pain perception at the spinal level. Because of the potential neurotoxicity after neuraxial use of racemic ketamine, intrathecal administration of the preservative‐free active compound, S (+)‐ketamine may be a valuable alternative. In this paper, we present a patient with severe neuropathic cancer pain successfully treated by continuous intrathecal infusion of morphine, bupivacaine, clonidine and S (+)‐ketamine. Moreover, quality of life measurements before and 3 weeks after the start of spinal treatment revealed an improvement in pain relief and a higher overall quality of life. No clinical signs of neurologic deficit were observed during spinal treatment with S (+)‐ketamine. However, the continuous intrathecal administration of S (+)‐ketamine should be considered as the last resort because there are no preclinical safety data with relevant concentrations on intrathecal use of S (+)‐ketamine.