Comparative study on the Coadjuvancy of Ketamine plus Morphine versus Morphine in Cancer Pain: Original Research

Abstract

Introduction: Cancer pain frequently disables and discourages patients, additionally it produces frustration not only for the patient but also for the team that performs the care. At one point, opioids no longer relieve pain and co-adjuvant measures are required to achieve the same results. The objective of this study was to compare the analgesic efficacy with morphine + ketamine in relation to morphine alone in cancer patients who do not respond to opioids.

Methods: The present retrospective observational study was carried out at the National Oncological Institute “Dr. Juan Tanca Marengo ”SOLCA-Guayaquil, with data from January 2014 to December 2015. All clinical records of patients older than 17 years who were admitted to the emergency room or hospitalized who underwent palliative treatment of pain from Oncological type, with a Karnofsky scale ? 40. Group 1 (G1) was made up of patients whose treatment was based solely on morphine with an adequate response, Group 2 (G2) was made up of patients in whom morphine + was used Ketamine due to lack of response prior to morphine use only. The perception of pain was measured on the visual analog scale (VAS), dose of morphine used (number of rescue doses), dose of Ketamine used, side effects. The sample was non-probabilistic, census type.

Results: 81 patients entered the study, 34/43 women (79%) in G1 and 24/38 (63%) in G2 P = 0.113.58. In both groups, VAS at admission 7 to 10 (severe), after the therapeutic intervention in G1 4 ± 1.25, in G2 3 ± 1.50 P = 0.78. Morphine dose in G1 10 ± 12.5 mg, in G2 20 ± 27.5 mg P = 0.406. Analgesic rescue in G1 29/43 (67%) in G2 19/38 (50%) OR 0.483 (95% CI 0.196-1.188) P = 0.113. Adverse effects were not different in both groups.

Conclusion: Ketamine used as an adjuvant with morphine allows to maintain pain control in the group of patients who usually do not respond to morphine with cancer pain, without increasing adverse effects.