Abstract Details

Title Ketamine and Dexmedetomidine Coma in Complex Regional Pain Syndrome

Topic Ethics, Pain and Palliative Care

Presentation(s) P02 - (-)

Poster/Presentation
Number 011

Objective

Background 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 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 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 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.

Authors/Disclosures
Jennifer Rasmussen-Winkler, MD (Baylor Scott & White) PRESENTER	Dr. Rasmussen-Winkler has nothing to disclose.
	No disclosure on file
	No disclosure on file
Rebecca Romero, MD, FAAN (UTHSCSA)	Dr. Romero has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Romero has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics . Dr. Romero has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech. Dr. Romero has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon.
	No disclosure on file
	No disclosure on file

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