The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
권호 표지

The Trial of Continuous Intravenous Infusion of Ketamine in Patients with Phantom Limb Pain -A case report-

환지통 환자에서 Ketamine 지속 정주에 의한 치료 경험 -증례보고-

  • Cheong, Yong Kwan (Department of Anesthesiology and Pain Medicine, School of Medicine, Wonkwang University) ;
  • Lee, Cheol (Department of Anesthesiology and Pain Medicine, School of Medicine, Wonkwang University) ;
  • Son, Yong (Department of Anesthesiology and Pain Medicine, School of Medicine, Wonkwang University) ;
  • Song, Yoon Kang (Department of Anesthesiology and Pain Medicine, School of Medicine, Wonkwang University) ;
  • Kim, Tai Yo (Department of Anesthesiology and Pain Medicine, School of Medicine, Wonkwang University) ;
  • Lee, Seung Woo (Department of Anesthesiology and Pain Medicine, School of Medicine, Wonkwang University)
  • 정용관 (원광대학교 의과대학 마취통증의학교실) ;
  • 이철 (원광대학교 의과대학 마취통증의학교실) ;
  • 손용 (원광대학교 의과대학 마취통증의학교실) ;
  • 송윤강 (원광대학교 의과대학 마취통증의학교실) ;
  • 김태요 (원광대학교 의과대학 마취통증의학교실) ;
  • 이승우 (원광대학교 의과대학 마취통증의학교실)
  • Received : 2006.06.09
  • Accepted : 2006.08.04
  • Published : 2006.12.30
Download PDF
⟨ Previous Next ⟩

Abstract

Phantom limb pain is a painful sensation from an absent limb. The onset of pain is generally early, with 75% of patients developing pain within the first few days after amputation. The frequency and duration of attacks tend to be reduced with time, although the prevalence and intensity remain constant. We report here a case of a 38-year-old man who exhibited the signs and symptoms of phantom limb pain due to the above-knee amputations of both legs. He was not responded to opioid therapy and a continuous intravenous infusion of ketamine, an N-methyl-D-aspatate receptor antagonist, reduced his severe pain.

Keywords

Acknowledgement

Supported by : 원광대학교

References

  1. Nikolajsen L, Jensen TS: Phantom limb pain. Br J Anaesth 2001; 87: 107-16 https://doi.org/10.1093/bja/87.1.107
  2. Hayes C, Brown A, Burstal R: Perioperative intravenous ketamine infusion for the prevention of persistent posr-ampuration pain: A randomized, controlled trial. Anaesth Intensive Care 2004; 32:330-8
  3. Nikolajsen L, Ilkjaer S, Kroner K, Christensen JH, Jensen TS: The influence of preamputation pain on postamputation stump and phantom pain. Pain 1997; 72: 393-405 https://doi.org/10.1016/S0304-3959(97)00061-4
  4. Loeser JD: Pain after amputation: Phantom limb and stump pain. In: Bonica's management of pain. 3rd ed. Edited by Loeser JD: Philadelphia, Lippincott Williams & Wilkins. 2001, pp 412-23
  5. Nikolajsen L, Hansen CL, Nielsen J, Keller J, Arendt-Nielsen L, Jensen TS: The effect of ketarnine on phantom pain: a central neuropathic disorder maintained by periphral input. Pain 1996; 67: 69-77 https://doi.org/10.1016/0304-3959(96)03080-1
  6. Jensen TS, Krebs B, Nielsen J, Rasmussen P: Immediate and longterm phantom limb pain in amputees: incidence, clinical characreristics and relationship ro pre-amputation pain. Pain 1985; 21:267-78 https://doi.org/10.1016/0304-3959(85)90090-9
  7. Kooijman CM, Dijkstra PD, Geertzen JHB, Elzinga A, Schans CP: Phantom pain and phantom sensations in upper limb amputees: an epidemiological study. Pain 2000; 87: 33-41 https://doi.org/10.1016/S0304-3959(00)00264-5
  8. Montoya P, Larbig W, Grulke N, Flor H, Taub E, Birbaumer N: The relationship of phantom limb pain to other phantom limb phenomena in upper extremity amputees. Pain 1997; 72: 87-93 https://doi.org/10.1016/S0304-3959(97)00004-3
  9. Wilkins KL, McGrath PJ, Finley GA, Katz J: Phantom limb sensations and phantom limb pain in child and adolescent amputees. Pain 1998; 78: 7-12 https://doi.org/10.1016/S0304-3959(98)00109-2
  10. Wart an SW, Hamann W, Wedley JR, McColl I: Phantom pain and sensation among British veteran amputees. Br J Anaesth 1997; 78: 652-9 https://doi.org/10.1093/bja/78.6.652
  11. Woolf CJ, Mannion RJ: Neuropathic pain: aetiology, symptoms, and management. Lancet 1999; 353: 1959-64 https://doi.org/10.1016/S0140-6736(99)01307-0
  12. Felsby S, Nielsen J, Arendt-Nielsen L, Jensen TS: NMDA receptor blockade in chronic neuropathic pain: a comparison of kerarnine and magnesium chloride. Pain 1995; 64: 283-91 https://doi.org/10.1016/0304-3959(95)00113-1
  13. Warncke T, Stubhaug A, Jorum E: Ketamine, an NMDA receptor antagonist, suppresses spatial and temporal properties of burn-induced secondary hyperalgesia in man: a double-blind, crossover comparison with morphine and placebo. Pain 1997; 72: 99-106 https://doi.org/10.1016/S0304-3959(97)00006-7
  14. Dertwinkel R, Heinrichs C, Senne I, Tegenthoff M, Weiss T, Malin JP, ct al: Prevention of severe phantom limb pain by perioperative administration of keramine-an observational study. Acute Pain 2002; 4: 9-13 https://doi.org/10.1016/S1366-0071(02)00004-9
  15. Eide PK, Stubhaug A, Oye I, Breivik H: Continuous subcutaneous administration of the N-methyl-D-aspartic acid (NMDA) receptor antagonist ketamine in the treatment. of post-herpetic neuralgia. Pain 1995; 61: 221-8 https://doi.org/10.1016/0304-3959(94)00182-E
  16. Stannard CF, Porter GE: Ketarnine hydrochloride in the treatment of phantom limb pain. Pain 1993; 54: 227-30 https://doi.org/10.1016/0304-3959(93)90214-A
  17. Yang HS, Lee KH, Lee C, Kim WT: Successful pain management for the posrherpetic neuralgia of ophthalmic nerve by continuous subcutaneous infusion of ketamine. Korean J Anes thesiol 1997; 33: 774-7 https://doi.org/10.4097/kjae.1997.33.4.774
  18. Felsby S, Nielsen J, Arendt-Nielsen L, Jensen TS: NMDA receptor blockade in chronic neuropathic pain: a comparison of ketamine and magnesium chloride. Pain 1995; 64: 283-91 https://doi.org/10.1016/0304-3959(95)00113-1
  19. llkjaer S, Petersen KL, Brennum J, Wernberg lvi, Dahl JB: Effect of systemic N-methyl-D-aspartate receptor antagonist (ketamine) on primary and secondary hyperalgesia in humans. Br J Anaesth 1996; 76: 829-34 https://doi.org/10.1093/bja/76.6.829