A case of burst ketamine therapy for opioid-resistant pain

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  • オピオイド抵抗性の疼痛に対しバースト・ケタミン療法を施行した１例

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Purpose: We report a patient with opioid-resistant pain in whom favorable pain control could be achieved with burst ketamine therapy. Case: A female in her fifties had been followed up due to pain associated with recurrence in the right thoracic cavity at the thoracotomy site after surgery for mesopharyngeal and hypopharyngeal cancer, free jejuna autograft reconstruction, and permanent tracheotomy. Oral drug administration became impossible due to dysphagia and nausea, and she was admitted because of unfavorable pain control. Although the opioid dose was increased, pain did not improve, and rescue medication was also ineffective. Opioid-resistant pain was suspected, and burst ketamine therapy was performed. The therapy was initiated with the continuous intravenous administration of 100 mg/day ketamine, which was increased to 300 mg/day and 500 mg/day after 24 and 48 hours, respectively, according to the degree of pain, and was continued for 5 days. As analgesic effects of morphine were obtained during ketamine administration, a higher dose of morphine was administered; as a result, a favorable pain control outcome was achieved, and the patient returned home. Conclusion: Burst ketamine therapy may be effective for the treatment of opioid-resistant pain. Palliat Care Res 2011;6(2): 358-364

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