The “no dialysis” option.

▶ Murtagh FE, Cohen LM, Germain MJ.

As people are living longer, the number of patients with end-stage renal failure will increase and increasing numbers of patients who have a 6-month survival are starting dialysis. Furthermore, the rate of dialysis withdrawal has increased. Dialysis has its' own risks and patients should be informed of the complex and challenging dialysis decisions. For a carefully selected group of patients, another option is not to dialyse and optimise medical and symptom management. This option would be based on clinician's recommendations along with patient choice and family input. Age, co-morbidities and the patients' functional capacity should be assessed as these are likely to indicate the patients' survival and potential benefit from dialysis.

Potentiation of μ-opioid receptor-mediated signaling by ketamine.

▶ Gupta A, Devi LA, Gomes I.

In this study the molecular mechanisms by which ketamine enhances opioid analgesia and prevents hyperalgesia are assessed. It was found that ketamine, via a non-NMDA receptor action, rapidly enhanced opioid-induced extracellular signal-regulated kinase (ERK) phosphorylation and increased resensitisation of opioid-mediated ERK signalling. This study indicates that ketamine might enhance opioid analgesia by increasing the effectiveness of opioid signalling.

Efficacy of small doses of ketamine with morphine to decrease procedural pain responses during open wound care.

▶ Arroyo-Novoa CM, Figueroa-Ramos MI, Miaskowski C, Padilla G, Paul SM, Rodríguez-Ortiz P, Stotts NA, Puntillo KA.

This randomized, cross-over study investigated differences in pain and adverse effects when 11 male patients received either intravenous 0.1 mg/kg morphine or 0.05 mg/kg morphine and 0.25 mg/kg ketamine before an open wound care procedure. Although the pain intensity during wound care was less with the addition of ketamine, over 90% of patients had altered sensations, hallucinations, blurred vision and had an increased diastolic blood pressure. The authors suggest that further research is needed to determine the optimal dose of ketamine and if a benzodiazepine would alleviate the side effects of ketamine.

The role of paracetamol and nonsteroidal anti-inflammatory drugs in addition to WHO Step III opioids in the control of pain in advanced cancer. A systematic review of the literature.

Nabal M, Librada S, …