Topical amitriptyline, ketamine, and lidocaine in neuropathic pain caused by radiation skin reaction: a pilot study

Uzaraga, Isabella; Gerbis, Bev; Holwerda, Eleanor; Gillis, Dan; Wai, Elaine S.

doi:10.1007/s00520-011-1240-7

Cited by 27 publications

(23 citation statements)

References 14 publications

(30 reference statements)

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“…The decision for this surgical procedure was secondary to our interest in evaluating the somatic nociceptive type of pain, as other types of pain, such a as neuropathic pain, have already been evaluated [3][4][5]. The three groups showed no differences regarding ASA status, gender, age, weight, height, and surgical time (p>0.05, Table 1).…”

Section: Resultsmentioning

confidence: 94%

“…Plasmatic measurements of ketamine/S(+)-ketamine was done through High Performance Liquid Chromatography (HPLC) [4,5]. Five-ml of venous blood was collected at the following times: 1) just prior the spinal puncture, 2) 30-min after transdermal cream application, 3) 4-hour, 4) 8-hour, 5) 16-hour and 6) 24-hour after transdermal cream application.…”

Section: Resultsmentioning

confidence: 99%

“…Transdermal delivery of racemic ketamine was demonstrated to prolong epidural lidocaine analgesia after gynaecological surgery [1], to promote pain relief post-tonsillectomy [2], to meliorate pain symptoms after induced neuropathy [3,4] and to improve pain in different circumstances [5,6]. As an example, the topical application of a compounded amitriptyline-ketamine formulation improved pain in 75% of patients suffering from erythromelalgia [6] and the use of topical 10% ketamine, might be a useful tool for the treatment of Hidradenitis Supprurativa pain [7].…”

Section: Introductionmentioning

confidence: 99%

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Transdermal Ketamine and S(+)-Ketamine as Adjuvants Following Orthopaedic Surgery under Bupivacaine Spinal Anaesthesia

Lauretti¹,

Amaral²,

Dias³

et al. 2014

J Phys Chem Biophys

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The aim of the study was to examine the perioperative analgesic effect of topical deliver of either ketamine or S(+)-ketamine in orthopaedic postoperative pain through clinical and laboratorial evaluation. 45 patients following minor orthopaedic surgery were randomized to one of three groups (n=15). Spinal anaesthesia was performed with 15 mg hyperbaric bupivacaine. Twenty min after the spinal puncture, a controlled delivery topical cream containing either 25 mg ketamine (KG), 25 mg S(+)-ketamine (+KG) or placebo (PG) was applied. Pain and adverse effects were assessed postoperatively for 24 h. Intravenous ketoprofen was available at patient request. The plasmatic concentration of ketamine and S(+)-ketamine was measured prior the spinal puncture, 30 min, 4-hour, 8-hour, 16-hour and 24-hour after topical application by High Performance Liquid Chromatography (HPLC). Time to first rescue analgesic was longer to both KG and +KG (10 hours) compared to the PG (5 hours); (p<0.05). Ketoprofen consumption (mg) in 24 hour was higher in the PG compared to the others (p<0.0005). Thirty-min after the transdermal application, ketamine and S(+)-ketamine were detectable in plasma in both KG and +KG by HPLC, and showed a dose-ranging curve during the 24-hour evaluation (p<0.02). Adverse effects were similar among groups. As conclusions, transdermal 25 mg ketamine or 25 mg S(+)-ketamine similarly prolonged the duration of analgesia following orthopaedic procedures under bupivacaine spinal blockade, demonstrated by clinical and laboratorial data.

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Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transdermal Ketamine and S(+)-Ketamine as Adjuvants Following Orthopaedic Surgery under Bupivacaine Spinal Anaesthesia

Lauretti¹,

Amaral²,

Dias³

et al. 2014

J Phys Chem Biophys

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“…In a small number of patients with refractory radiation associated LNP, an amitriptylineketamine-lidocaine combination cream was found to be safe and effective [39]. Ketamine has been used in topical preparations with concentrations of 2% with systemic absorption in less than 10% of subjects [40].…”

Section: Other Topical Adjunctsmentioning

confidence: 99%

The role of topiceuticals in cancer pain

Paisley

Serpell²

2017

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of review:Pain is one of the most common and feared symptoms associated with a new diagnosis of cancer and its subsequent treatment. Unfortunately, it remains undertreated in around one third of patients. It has been recently postulated that one mechanism for this could be failure to recognise neuropathic pain. One attractive option in both the case of neuropathic pain and pain associated with intolerable side effects of prescribed opioids is the use of 'topiceuticals', as a means of targeted pain relief with potentially fewer side effects. This review summarises the evidence base for the various topiceuticals available for the treatment of localised neuropathic pain. Recent findings:The recent evidence base for established treatments such as capsaicin and lignocaine is examined. A variety of novel and previously used therapies are considered. Summary:The use of topiceuticals in localised neuropathic pain associated with malignancy remain a valuable option with many advantages over systemic treatments. In addition to anecdotal reports of efficacy, there is a growing body of evidence to consider the early use of topical lignocaine and capsaicin in this context. The authors' have proposed a guideline including the use of topiceuticals to aid in the management of neuropathic pain

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“…Two open-label trials, the first involving 28 patients with neuropathic pain who were treated with the combination amitriptyline 2%/ketamine 1%, showed pain reduction and encouraging results [96, 99]. Amitriptyline and ketamine topical combinations have also been used in patients suffering from cancer pain, such as in a study showing that a topical amitriptyline, ketamine, and lidocaine preparation was safe and effective in alleviating neuropathic pain caused by radiation dermatitis [100]. …”

Section: Other Drug Options and Combinationsmentioning

confidence: 99%

Skin Matters: A Review of Topical Treatments for Chronic Pain. Part Two: Treatments and Applications

et al. 2015

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In Part One of this two-part series, we discussed skin physiology and anatomy as well as generalities concerning topical analgesics. This modality of therapy has lesser side effects and drug–drug interactions, and patients tolerate this form of therapy better than many oral options. Unfortunately, this modality is not used as often as it could be in chronic pain states, such as that from neuropathic pain. Part Two discusses specific therapies, local anesthetics, and other drugs, as well as how a clinician might use specific aspects of a patient’s neuropathic pain presentation to help guide them in the selection of a topical agent.

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Topical amitriptyline, ketamine, and lidocaine in neuropathic pain caused by radiation skin reaction: a pilot study

Abstract: AKL was a safe intervention to use with minimal toxicity and good compliance. It significantly reduced several measures of neuropathic pain associated with radiation dermatitis. A larger-scale study would require recruitment from multiple centers.

Cited by 27 publications

References 14 publications

Transdermal Ketamine and S(+)-Ketamine as Adjuvants Following Orthopaedic Surgery under Bupivacaine Spinal Anaesthesia

Transdermal Ketamine and S(+)-Ketamine as Adjuvants Following Orthopaedic Surgery under Bupivacaine Spinal Anaesthesia

The role of topiceuticals in cancer pain

Skin Matters: A Review of Topical Treatments for Chronic Pain. Part Two: Treatments and Applications

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