Avaliação clínica comparativa entre a cetamina e a clonidina por via peridural no tratamento da dor crônica neuropática

Abstract

RESUMO Background and Objectives -Chronic pain results in an increased response of spinal cord dorsal horn neurons due to the action of several mediators released by neuronal terminals, including the agonists of N-methyl-D-aspartate receptors. In addition to sensory ascending pathways, inhibitory descending pathways modulate pain, including a 2 -adrenoceptors located on primary afferent terminals and on the spinal cord. This study was designed to investigate the anti-noxious effects of epidural ketamine (N-methyl-D-aspartate antagonist) or epidural clonidine (a 2 -adrenergic agonist) in the treatment of neuropathic chronic pain.Methods -Twenty-six adult patients, with neuropathic chronic pain not responsive to conservative therapy, were randomly divided into two groups in this prospective double-blind study. All patients were regularly taking 50-75 mg oral amitriptyline at bedtime. Pain was evaluated through a 10 cm visual analog scale (VAS), with "zero" corresponding to "no pain" and 10

Efficacy and Safety of Ketamine in the Treatment of Neuropathic Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Among the 18 eligible randomized control studies (RCTs), they took place in a variety of settings ( Table 1 ) including Brazil, 29 , 32 , 41 , 42 Canada, 36 Denmark, 35 Egypt, 27 , 28 France, 34 Italy, 40 Netherlands, 25 , 30 , 37 Norway, 38 South Korea, 31 United Kingdom, 33 United States of America. 26 , 39 Sample sizes ranged from eight 38 to 214 35 participants ( Table 1 ).…”

Total intravenous anaesthesia with propofol-racemic ketamine and propofol-S-ketamine: a comparative study and haemodynamic evaluation in dogs undergoing ovariohysterectomy

“…In man, S(+)Ketamine has an anaesthetic-analgesic effect two to four times greater than racemic ketamine (White et al 1985, Mathisen et al 1995, Lauretti et al 2000, and its hyptonic effect is more potent than that of the R(-) isomer (Terra et al 1999), witch allows the use of lower doses of S(+) ketamine when compared to racemic ketamine. Rossetti et al (2008) observed in stallions undergoing castration, a higher analgesic effect of S(+)-ketamine, which was represented by a more stable physiologic parameters during the procedure and also a lower anesthetic requirement.…”

“…In this case, one can question the two to four fold increase in anaesthetic and analgesic potency of S(+)Ketamine in relation to racemic ketamine (White et al 1985, Mathisen et al 1995, Lauretti et al 2000. Moreover, it is also possible that the doses of propofol and/or both ketamines could be readjusted.…”

“…In man, S(+)Ketamine has an anaesthetic-analgesic effect two to four times greater than racemic ketamine (White et al 1985;Mathisen et al 1995;Lauretti et al 2000), and its hyptonic effect is more potent than that of the R(-) isomer (Terra et al 1999), allowing the use of lower doses of S(+) ketamine compared to racemic ketamine.…”

Efeito da raquianestesia com bupivacaína associada ou não à clonidina em gatas submetidas a ovariosalpingohisterectomia

“…Doses baixas de anestésicos locais bloqueiam totalmente as raízes sensitivas e parcialmente ou não bloqueiam as raízes motoras (IMBELLONI; BEATO; GOUVEIA, 2004).Em pacientes humanos com câncer que apresentam dor neuropática, a clonidina vem sendo estudada como alternativa para o controle da dor associada aos opioides. Apesar de, assim como a morfina, apresentar sedação e boca seca, quando utilizada em associação há redução desses efeitos colaterais demonstrando ser uma alternativa terapêutica analgésica eficaz(EISENACH et al, 1995), provavelmente por ação antinociceptiva central(LAURETTI et al, 2002).…”