[Cancer pain: beneficial effect of ketamine addition to spinal administration of morphine-clonidine-lidocaine mixture].
OBJECTIVE
To assess the benefit of ketamine addition to a morphine-clonidine-lidocaine mixture administered continuously by the intrathecal route for the treatment of cancer pain.


METHODS
Case series analysis.


METHODS
Four patients experiencing cancer pain with nociceptive and neuropathic components were treated with a continuous intrathecal administration of a mixture of ketamine (10 mg)-morphine (1-20 mg)-clonidine (30 micrograms)-lidocaine (20 mg) in 12 mL of normal saline, injected daily with an infusor (Baxter) pump. This treatment, associated with oral administration of sustained release morphine (SRM), was extended over 35 to 58 days, until the death of the patients.


RESULTS
Either the secondary addition of ketamine to the morphine-clonidine-lidocaine mixture after the 40th and 15th days of treatment in patients no 1 and 2 respectively, because of a loss of efficiency of the mixture, or the immediate administration of the association of the four agents in patients no 3 and 4 provided efficient analgesia, unchanged over time, without significant adverse effects and allowed a decrease of the SRM doses.


CONCLUSIONS
Ketamine by intrathecal route potentiates analgesia obtained with morphine-clonidine and lidocaine, while impeding the development of a tolerance vis-à-vis the former.
Muller
A
A
Département d'anesthésiologie, hôpitaux universitaire de Strasbourg, hôpital civil, France.
Lemos
D
D
D000368:Aged; D000700:Analgesics / Q000008:administration & dosage*; D002408:Catheters, Indwelling; D003000:Clonidine; D004338:Drug Combinations; D004357:Drug Synergism; D005260:Female; D006801:Humans; D007260:Infusion Pumps; D007278:Injections, Spinal; D007649:Ketamine; D008012:Lidocaine; D008297:Male; D008875:Middle Aged; D009020:Morphine; D009369:Neoplasms / Q000150:complications / Q000628:therapy*; D010146:Pain / Q000209:etiology; D059408:Pain Management
D000700:Analgesics; D004338:Drug Combinations; D007649:Ketamine; D009020:Morphine; D008012:Lidocaine; D003000:Clonidine
Douleurs cancéreuses:effet bénéfique de l'adjonction de kétamine au mélange morphine-clonidine-lidocaïne administré par voie intrathécale.