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- W66019585 abstract "OBJECTIVE: Complex regional pain syndrome (CRPS) is a debilitating disease which can persist despite aggressive treatment. We report the case of an induced ketamine and dexmedetomidine coma for refractory CRPS. BACKGROUND: CRPS is defined as pain with allodynia and autonomic dysregulation. The etiology is likely related to multiple factors including central pain sensitization through NMDA receptor up-regulation. Ketamine at sub-anesthetic doses has demonstrated improvement in pain, however anesthetic dose ketamine may have better long term efficacy. The alpha2-adrenergic effects of dexmedetomidine should synergistically enhance the analgesic effect of ketamine, while reducing the cardiovascular side effects. DESIGN/METHODS: 45 year-old Caucasian male presented with a 2-year history of left hand allodynia, edema, and hyperhidrosis, 6 months after peripheral IV insertion. The pain spread from the left hand to his entire left side, scrotum, rectum and scalp. Prior failed therapy included steroids, neuropathic medications, and sympathetic ganglion blockade. He maintained pain control with 120mg of morphine ER twice daily. Due to the rapid spread of his pain and minimal response to standard treatments, we initiated treatment with a medically induced coma with Ketamine 7mg/kg/hr, Dexmedetomidine 1.5 mcg/kg/hr and Midazolam 17mg/hr. Fentanyl was given for the first day, then weaned. Level of sedation was maintained at a Ramsay score of -4 to -5 with 24 hour EEG monitoring to verify deep coma. RESULTS: After a five day coma, our patient reported 100% resolution of pain without analgesic or opioid usage. He developed severe hallucinations and anxiety as an expected side effect of ketamine, which were treated with a chlordiazepoxide taper. To date, our patient remains pain free (45 days post treatment). CONCLUSIONS: We report the novel combination of anesthetic doses of ketamine and dexmedetomidine to treat refractory CRPS. Continued investigation into this therapy is warranted as a potential treatment regimen for CRPS. Disclosure: Dr. Rasmussen has nothing to disclose. Dr. Malave has nothing to disclose. Dr. Soto-Gomez has nothing to disclose. Dr. Romero has received personal compensation for activities with Novartis, Questcor, and Teva Neuroscience as a consultant. Dr. Eckmann has nothing to disclose." @default.
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- W66019585 date "2013-02-12" @default.
- W66019585 modified "2023-09-22" @default.
- W66019585 title "Ketamine and Dexmedetomidine Coma in Complex Regional Pain Syndrome (P02.011)" @default.
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