静脉注射氯胺酮治疗慢性疼痛:系统回顾和荟萃分析

Medicine Advances Pub Date : 2023-12-19 DOI:10.1002/med4.45
Peter Olujimi Odutola, Ruchir Gupta
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引用次数: 0

摘要

慢性疼痛给全球数百万患者的身体、情感和社会经济造成了巨大损失。传统的药物干预往往不足以为严重慢性疼痛患者提供持久有效的镇痛效果。然而,近年来,氯胺酮静脉输注疗法已成为一种前景广阔的替代治疗方式。氯胺酮静脉输注疗法治疗慢性疼痛的有效性已在神经病理性疼痛、纤维肌痛、复杂区域疼痛综合征(CRPS)和幻肢痛等多种疼痛病症中进行了研究。然而,不同的患者人口统计学特征、不同的镇痛测量终点以及研究中不一致的患者人数导致了相互矛盾的结果。本研究旨在对氯胺酮静脉输注疗法在顽固性疼痛中的应用进行最新的荟萃分析。研究人员按照 PRISMA 指南进行了检索,以比较氯胺酮静脉输注与对照组(安慰剂、咪达唑仑、加巴喷丁、氢吗啡酮和普瑞巴林)在慢性疼痛患者中的疗效。在分析过程中,对 Medline、Cochrane 和 Embase 进行了全面检索。两名独立研究人员确定了比较静脉注射氯胺酮与对照组的随机双盲和非随机试验。使用Review Manager 5.4.1对数据进行了仔细检查,主要关注疼痛评分。此外,还分析了睡眠质量等次要结果以及恶心、幻觉和镇静等副作用。静脉注射氯胺酮可显著降低疼痛评分(平均差异-1.05;95% CI -1.72, -0.39;p = 0.002),而睡眠质量(平均差异0.00;95% CI -0.12, 0.12;p = 1.00)在不同研究中无显著差异。恶心(风险比 1.42;95% CI 0.84,2.39;p = 0.19)、幻觉(风险比 1.08;95% CI 0.67,1.76;p = 0.75)和镇静(风险比 1.05;95% CI 0.24,4.54;p = 0.95)的结果在各研究间无明显差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
IV ketamine infusion therapy for chronic pain: A systematic review and meta‐analysis
Chronic pain exerts a significant physical, emotional, and socioeconomic toll on millions of patients worldwide. Traditional pharmacological interventions are often inadequate in providing lasting and effective pain relief for patients suffering from severe chronic pain. However, in recent years, intravenous ketamine infusion therapy has emerged as a promising and alternative treatment modality. The effectiveness of intravenous ketamine infusion therapy in treating chronic pain has been investigated in various pain conditions, such as neuropathic pain, fibromyalgia, complex regional pain syndrome (CRPS), and phantom limb pain. However, varied patient demographics, different endpoints for measuring analgesia, and inconsistent numbers of patients in studies have led to conflicting results. The objective of the present inquiry is to undertake a contemporary updated meta‐analysis of the application of IV ketamine infusion therapy in the context of persistent pain.A search was conducted, adhering to the PRISMA guidelines, to compare the efficacy of IV Ketamine infusion versus control (placebo, midazolam, gabapentin, hydromorphone, and pregabalin) among individuals with chronic pain. During the analysis, Medline, Cochrane, and Embase were thoroughly searched. Two independent investigators identified randomized double‐blind and non‐randomized trials comparing IV Ketamine infusions with controls. Review Manager 5.4.1 was used to scrutinize the data, with the main focus on pain scores. Secondary outcomes such as quality of sleep, as well as side effects such as nausea, hallucinations, and sedation, were also analyzed. Sixteen studies were included involving 1080 patients.The pain score was significantly reduced by IV Ketamine (Mean difference −1.05; 95% CI −1.72, −0.39; p = 0.002), while the quality of sleep (Mean difference 0.00; 95% CI −0.12, 0.12; p = 1.00) was not significantly different between studies. Nausea (risk ratio 1.42; 95% CI 0.84, 2.39; p = 0.19), hallucinations (risk ratio 1.08; 95% CI 0.67, 1.76; p = 0.75), and sedation (risk ratio 1.05; 95% CI 0.24, 4.54; p = 0.95) outcomes were not significantly different among the studies.Our meta‐analysis indicates that IV Ketamine infusion is efficacious and safe in patients with chronic pain.
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