Resumen

MARTINS, Olímpia  y  GONCALVES, José Ferraz. Cetamina em Cuidados Paliativos Oncológicos: Um Desafio Experiência de um ServiçoKetamine in Context of Oncologic Palliative Care: A Challenge Experience of a Palliative Care Service. Medicina Interna [online]. 2020, vol.27, n.1, pp.25-29. ISSN 0872-671X.  https://doi.org/10.24950/O/280/19/1/2020.

Introduction: Ketamine is a dissociative anaesthetic agent which has analgesic and antidepressants properties in subanaesthetic doses, and it has been used as an adjuvant treatment for opioid-refractory cancer pain. The aim of this study was to assess the use of ketamine in a palliative care centre. Material and Methods: Retrospective study for thirty months in an oncologic adult palliative care service of patients undergoing treatment with ketamine. Results/Discussion: Twenty patients were analysed. Ages varied from 26 to 78 years, median of 54.5. Ketamine was used as an adjuvant treatment for opioid-refractory cancer pain in 18 patients, and in two to treat depression. In the first group all patients had unbearable pain and 22% showed signs of opioids adverse effects; 73% had mixed pain. They were treated with high doses of opioids-equivalent to a median dose of 422.5 mg/day of oral morphine. The average dose of ketamine was 85 mg/day, median 80 mg/day, in continuous intravenous or subcutaneous infusion in 90% of them. The dose of opioid decreased in 12% and the rescue opioid dose in 53%. In 70% the pain was relieved. Improvement in pain was found in an average of 4.8 days. All received neuroleptics with or without benzodiazepines. The psychotomimetic side effects in one patient forced to discontinue ketamine. Patients with depression demonstrated an improvement in mood as the main response to a single dose of ketamine. Conclusion: The results of this study showed ketamine efficiency in subanaesthetic doses to help control the cancer pain. Despite being a promising therapeutic approach in palliative care units more research must be carried out to define the role of ketamine in Palliative Care.

Palabras clave : Ketamine; Pain Management; Palliative Care.

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