Resumo

CORTINAS SAENZ, Manuel et al. Treatment with ketamine mouthwashes with and without transmucosal fentanyl in major opiate-resistant orofacial cancer pain. Rev Esp Cirug Oral y Maxilofac [online]. 2015, vol.37, n.2, pp.80-86. ISSN 2173-9161.  https://dx.doi.org/10.1016/j.maxilo.2013.11.002.

Purpose: The objective of this study was to determine if an oral ketamine mouth wash and expectorant, that may or may not rinse transmucosal fentanyl, was a safe and effective method to alleviate a series of various difficult to control orofacial pain of cancer origin. Material and methods: A prospective review was made of the medical charts of 20 patients, finding 8 patients who received ketamine mouthwash (40 mg = 4 ml), 8 patients who received ketamine mouthwash and oral transmucosal fentanyl citrate 200 mcg, and 4 patients with systemic opioids for refractory orofacial and mucositis pain. Results: Of the 20 patients, 16 had orofacial or mucositis pain refractory to a mixture of lidocaine and opioids. The effectiveness of ketamine mouthwash was 50% (8/16 patients). The combination of ketamine and/or fentanyl transmucosal had an analgesic efficacy of 94.1% (15/16 patients). The adverse effects were associated with the ketamine mouthwash; all side effects were transient and subsided when the ketamine mouthwash was stopped. Conclusion: Ketamine mouthwash for orofacial pain due to cancer may be an effective treatment option. In cases of reported episodes of breakthrough pain, the combination of a ketamine mouthwash and oral transmucosal fentanyl citrate may be a viable treatment option in refractory mucositis pain.

Palavras-chave : Orofacial pain; Breakthrough pain; Cancer; Mucositis; Ketamine.

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