Intravenous Ketamine for Cancer Pain: A Single-Center Retrospective Analysis Comparing Fixed-Rate Versus Weight-Based Dosing.

Leslie Siegel, Kyle Quirk, Gary Houchard, Sarah Ehrman, Eric McLaughlin, Omar Hajmousa, Maureen Saphire
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Abstract

Although weak evidence exists to support subanesthetic ketamine for cancer pain treatment, successful use may be hindered in the absence of standardized dosing guidance. We aimed to compare the success rates of intravenous ketamine fixed-rate versus weight-based dosing strategies for cancer pain treatment, and to assess patient characteristics that correlate with treatment success. We conducted a single-center retrospective review including non-critically ill adults with cancer pain who received subanesthetic ketamine for at least 24-h. All patients received fixed-rate ketamine; weight-based doses were retrospectively determined using total body weight. Treatment was considered successful if after reaching the maximum prescribed ketamine dose the patient had a 30% reduction in: baseline pain score, as-needed opioid use, or total morphine equivalent daily dose over a standardized 24-h. Of 105 included patients, 51 (48.6%) successfully responded to ketamine. Responders had lower fixed-rate ketamine doses compared to non-responders (median[IQR] 15 mg/hr[10-15] vs. 15 mg/hr[15-20], p = 0.043), but no difference in retrospectively calculated weight-based doses (0.201 ± 0.09 mg/kg/hr vs. 0.209 ± 0.08 mg/kg/hr, p = 0.59). Responders had higher daily opioid requirements at baseline compared to non-responders (p = 0.04). Though underpowered, our findings suggest that weight-based ketamine dosing may not convey additional benefit over fixed-rate dosing.

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静脉注射氯胺酮治疗癌症疼痛:固定剂量与按体重给药的单中心回顾性分析比较。
尽管有微弱的证据支持将麻醉下氯胺酮用于癌痛治疗,但由于缺乏标准化的剂量指导,成功使用氯胺酮可能会受到阻碍。我们旨在比较静脉注射氯胺酮固定剂量与基于体重的剂量策略治疗癌症疼痛的成功率,并评估与治疗成功率相关的患者特征。我们进行了一项单中心回顾性研究,研究对象包括接受麻醉下氯胺酮治疗至少 24 小时的非重症成人癌痛患者。所有患者都接受了固定剂量的氯胺酮;根据总重量回顾性地确定了基于体重的剂量。在达到氯胺酮的最大处方剂量后,如果患者的基线疼痛评分、阿片类药物的按需使用量或吗啡当量日总剂量在标准的24小时内减少了30%,则认为治疗成功。在纳入的 105 名患者中,有 51 人(48.6%)对氯胺酮成功产生了反应。与无反应者相比,有反应者的氯胺酮固定剂量较低(中位数[IQR] 15 mg/hr[10-15] vs. 15 mg/hr[15-20], p = 0.043),但回顾性计算的基于体重的剂量没有差异(0.201 ± 0.09 mg/kg/hr vs. 0.209 ± 0.08 mg/kg/hr,p = 0.59)。与无应答者相比,有应答者的基线阿片类药物日需求量更高(p = 0.04)。我们的研究结果表明,基于体重的氯胺酮剂量可能不会比固定剂量带来更多益处。
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CiteScore
1.60
自引率
9.10%
发文量
40
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