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Anaesthesia, Pain, Intensive Care and Emergency Medicine — A.P.I.C.E. pp 903–913Cite as

Pain relief by ketamine

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Abstract

Although advances in techniques for anaesthesia, surgery, and the protection of organs have resulted in reductions in age- and risk-adjusted mortality and morbidity, the incidence of perioperative pain has changed little over the past years. Given the increasing numbers of elderly people with age-related painful conditions and the improvements in the management of cancer with increased life expectancy, there is a large clinical need for successful perioperative pain treatment [1]. Because clinical efforts for pain therapy are currently being re-directed from empirical strategies to more targeted mechanistic approaches [2], ketamine has increasingly been used for treatment of acute and chronic pain in the perioperative setting [3, 4]. This development has been caused partly by enhanced knowledge of pathophysiological mechanisms that operate in pain pathways, where the importance of the activation of excitatory glutamate receptors of the N-methyl-d-aspartate (NMDA) subtype in nociceptive transmission, synaptic plasticity and pain sensitisation has been established for humans [5]. Ketamine binds non-competitively to the phencyclidine-binding site of the NMDA receptor channel [6]. When clinically used at subanaesthetic doses, the drug’s analgesic efficacy correlates well with its inhibiting action on NMDA receptor-mediated pain facilitation [7, 8]. The clinical relevance of ketamine effects on other potential pain control mechanisms is not yet apparent.

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Authors
  1. S. Himmelseher
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  2. E. Kochs
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Editors and Affiliations

  1. Department of Perioperative Medicine, Intensive Care and Emergency, Trieste University School of Medicine, Trieste, Italy

    Antonino Gullo M.D. (Head) (Head)

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Himmelseher, S., Kochs, E. (2004). Pain relief by ketamine. In: Gullo, A. (eds) Anaesthesia, Pain, Intensive Care and Emergency Medicine — A.P.I.C.E.. Springer, Milano. https://doi.org/10.1007/978-88-470-2189-1_20

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  • DOI: https://doi.org/10.1007/978-88-470-2189-1_20

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