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Ketamina para el dolor agudo y crónico: más allá de la anestesia
Hao G Duong1, Tariq G Pulskamp1, Daniel J Berlau1
1School of Pharmacy, Regis University School of Pharmacy, Denver, CO, USA.
Pain management
|February 9, 2026
Resumen
La ketamina ofrece alivio del dolor no opioide al bloquear los receptores de N-metil-D-aspartato (NMDA), reduciendo las puntuaciones de dolor y el uso de opioides. Si bien es eficaz para el dolor agudo y crónico, sus beneficios a largo plazo y los efectos secundarios requieren una cuidadosa consideración.
Área de la Ciencia:
- Anestesiología Anestesiología.
- Farmacología Farmacología.
- Manejo del dolor Manejo del dolor.
Sus antecedentes:
- El papel de la ketamina se ha expandido más allá de la anestesia a la analgesia no opioide.
- Actúa como un antagonista no competitivo del receptor del N-metil-D-aspartato (NMDA).
- La ketamina influye en la sensibilización central, la tolerancia a los opiáceos y las vías descendentes del dolor.
Objetivo del estudio:
- Revisar la eficacia y utilidad de la ketamina en diversos entornos de dolor.
- Evaluar su papel en el manejo del dolor agudo, perioperatorio y crónico.
- Para discutir sus beneficios, limitaciones y efectos adversos.
Principales métodos:
- Revisión de estudios clínicos y pruebas sobre las propiedades analgésicas de la ketamina.
- Análisis del mecanismo de acción de la ketamina en dosis subaestéticas (0,1-0,5 mg/kg).
- Evaluación de su uso en el síndrome de dolor regional agudo, perioperatorio, complejo (CRPS) y el dolor por cáncer.
Principales resultados:
- La ketamina subanestésica reduce las puntuaciones de dolor y el consumo postoperatorio de opioides.
- La eficacia analgésica es comparable a los opioides en entornos agudos / perioperatorios; no se ha demostrado la superioridad.
- Durabilidad limitada en el dolor crónico (CRPS) y resultados variables en el dolor por cáncer.
- Los efectos secundarios a corto plazo incluyen mareos y disforia; el uso prolongado está limitado por síntomas psicomiméticos, lesión hepatobiliar y cistitis.
Conclusiones:
- La ketamina proporciona analgesia dependiente del contexto y que ahorra opioides con una utilidad clínica específica.
- Su papel en el control del dolor es dirigido, lo que requiere una cuidadosa selección y dosificación del paciente.
- Las expectativas realistas de beneficio son cruciales para su uso efectivo.
Palabras clave:
El receptor NMDA es el receptor NMDA.analgésico y analgésico.El dolor del cáncer el dolor del cáncer.Síndrome de dolor regional complejo síndrome de dolor regional complejo.La esketamina es una sustancia que contiene esketamina.el ahorro de opiáceos.perioperatorio perioperatorioPrehospitalario y prehospitalario.
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