Epidural Ketamine for Control of Postoperative Pain

Brock‐Utne, John G.; Rubin, Joseph; Mankowitz, E

doi:10.1213/00000539-198609000-00017

Cited by 5 publications

(1 citation statement)

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“…In fact after the epidural application of this dosage the authors did not note the onset of a motor block or of systemic effects. Subsequently, Brock-Utne et al [82], following their initial enthusiasm on ketamine by epidural means [62] concluded that not even epidural doses of 50 mg are able to provide an adequate postoperative analgesic response.…”

Section: Epidural Administrationmentioning

confidence: 99%

The epidural and intrathecal administration of ketamine

Beltrutti

Trompeo

Santo

1999

Current Review of Pain

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An overview of the spinal administration of ketamine is presented. Ketamine acts as a noncompetitive antagonist of the NMDA receptor Ca(++ channel pore. This effect provides interesting possibilities in pain therapy. However, there are still contrasting results that seem to be due to a lack of comparative controlled studies. The presence of systemic and neurotoxic effects presently limits clinical use).

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Section: Epidural Administrationmentioning

confidence: 99%

The epidural and intrathecal administration of ketamine

Beltrutti

Trompeo

Santo

1999

Current Review of Pain

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Intrathekale und epidurale Applikation von Nichtopioidanalgetika zur Therapie akuter und chronischer Schmerzen

Donner¹,

Tryba²,

Zenz³

et al. 1994

Schmerz

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Nociceptive stimuli are modulated at the dorsal horn of the spinal cord. This modulation is performed by various systems working independently complementarily, additively or supra-additively. Non-opioid analgesics relieve pain without a motor blockade. In contrast to spinal opioids a reduced risk of respiratory depression is expected. In the therapy of chronic pain non-opioid analgesics may be an alternative, given alone or in combination with an opioid. Clinically relevant dosages for antinociception mediated by the alphaadrenoceptoragonistclonidine are >/=150 mug epidurally. Clonidine is effective in reducing acute and chronic pain. In combination with opioids the action of the opioids is intensified. Clonidine intensifies and prolongs the action of local anesthetics. If opioid tolerance occurs, epidural clonidine alone or in combination with an opioid has good antinociceptive action.Midazolam, a water-soluble benzodiazepine, was injected spinally for the reduction of pain for various indications (postoperative, malignancy, chronic back pain, spinal spasticity). Spinal benzodiazepine should not be injected into the spine in patients until it has been proven that there are no neurotoxic effects. Intrathecally injectedbaclofen is a well-known means of reducing spinal spasticity. Used in this way, it may have a secondary analgesic effect. No significant direct analgesic effect has so far been demonstrated. Spinalcalcitonin often leads to insufficient pain relief when given alone. Combination with an opioid may reduce the dosage of the opioid. Nausea and vomiting are frequent side effects of spinal calcitonin. Intrathecalsomatostatin produces antinociception. However, in animal studies neurotoxic action has been observed. Administration in man has not yet been proved to be safe. Spinalketamine has procluted controversial results in clinical studies, and has not yet been excluded that the substance is not neurotoxic.Lysine acetylsalicylic acid (L-ASA) has been given intrathecally for the therapy of severe cancer pain and chronic back pain. In most patients good analgesia was observed up to 2 months after a single injection. If neurotoxity can be excluded, L-ASA may be an alternative in the therapy of cancer pain before neurodestructive therapy is done.

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Supplements to neuraxial blockade in paediatric patients — where are we now?

Doyle

2000

Acute Pain

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Epidural Ketamine for Control of Postoperative Pain

Cited by 5 publications

References 0 publications

The epidural and intrathecal administration of ketamine

The epidural and intrathecal administration of ketamine

Intrathekale und epidurale Applikation von Nichtopioidanalgetika zur Therapie akuter und chronischer Schmerzen

Supplements to neuraxial blockade in paediatric patients — where are we now?

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