Ketamine Infusion for Pain Control in Acute Pediatric Sickle Cell Painful Crises

Hagedorn, Jonathan M; Monico, Evelyn C.

doi:10.1097/pec.0000000000000978

Cited by 21 publications

(16 citation statements)

References 28 publications

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“…LOS also varied widely in other case reports and case series in this patient population (range 10-38 days). 17,20 The results of this study also revealed similar findings to previously published case reports that inpatient opioid usage may be decreased when combined with low-dose ketamine infusions for VOC in adult patients with SCD. 16,19,21 Though reduction in opioid doses did not reach statistical significance possibly due to sample size, we found that when compared to the median opioid dose prior to starting ketamine, average opioid use was numerically decreased by 20% in the 24 hours after starting ketamine and by 19% in the 24 hours after ketamine was discontinued.…”

Section: Discussionsupporting

confidence: 89%

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Impact of Ketamine in the Management of Painful Sickle Cell Disease Vaso-Occlusive Crisis

Froomkin¹,

Knoebel

Dickerson

et al. 2021

Hosp Pharm

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The aim of the study is to determine if ketamine infusions in combination with opioid therapy for the management of sickle cell disease (SCD) presenting with vaso-occlusive crisis (VOC) resulted in a length-of-stay difference compared to when ketamine was not utilized. This single center, retrospective, observational study performed at an academic medical center evaluated 12 adult patients with SCD-VOC who received a ketamine infusion with standard opioid therapy between 2014 and 2017. Patients were excluded if the primary diagnosis was not VOC or they did not survive to discharge. Additionally, safety and oral morphine equivalents at various time points were compared. Patients were used as their own control using the previous SCD-VOC hospitalization to evaluate the relative impact of ketamine. Wilcoxon signed-rank and rank sum were used in statistical analysis. When comparing opioid doses during the ketamine infusion, a P-value <.005 was considered statistically significant to account for multiple comparisons. The median length-of stay when ketamine was employed was similar to the previous admission with only opioid therapy (12 vs 12 days, P = .317). The median opioid dose 24 hours prior to starting ketamine was greater than during the first 24 hours of ketamine use (1278 vs 1020 mg, P = .022) and 24 hours after stopping ketamine (1278 vs 1035 mg, P = .014); however, this was not statistically significant. During 5 ketamine infusions, patients experienced side effects; however, only 1 necessitated transfer to the intensive care unit. Compared to standard opioid therapy, ketamine infusions were generally well tolerated and may be effective at reducing opioid use during SCD-VOC but did not decrease hospital length-of-stay.

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Section: Discussionsupporting

confidence: 89%

“…LOS also varied widely in other case reports and case series in this patient population (range 10-38 days). 17,20…”

Section: Discussionmentioning

confidence: 99%

Impact of Ketamine in the Management of Painful Sickle Cell Disease Vaso-Occlusive Crisis

Froomkin¹,

Knoebel

Dickerson

et al. 2021

Hosp Pharm

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“…Sickle cell disease (SCD) can cause many complications, including hemolytic anemia, susceptibility to bacterial infections, stroke, organ failure, and recurrent vaso-occlusive pain episodes (VOEs). 1,2 Acute VOEs are defined as new onset of pain lasting at least four hours, for which there is no alternative explanation. 3 VOE pain is a significant cause of morbidity and accounts for more than 90% of hospital admissions for patients with SCD.…”

Section: Introductionmentioning

confidence: 99%

A systematic review of ketamine for the management of vaso‐occlusive pain in sickle cell disease

Harris

Vilk

Heeney

et al. 2021

Pediatric Blood & Cancer

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Vaso-occlusive episodes (VOEs) are a common complication of sickle cell disease (SCD) and a significant cause of morbidity. Managing VOE pain can be difficult and complex.Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has been used to manage VOE pain. This systematic literature review synthesizes research published from 2010 to 2020 on the use of ketamine infusion to decrease VOE pain. The review demonstrates that ketamine, a safe and effective treatment for VOE pain, could be considered more widely. However, the significant variability among published clinical studies with regard to dosing, timing of initiation, duration of infusion, and timing of discontinuation highlights the need for standardized ketamine infusion protocols for the management of VOE pain. We conclude with a brief discussion of key components of a potential standardized protocol supported by the literature reviewed as well as areas for future investigation.

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“…Considering the paediatric setting, the role and effectiveness of ketamine infusion for a painful SC crisis have been investigated in two recent papers. 28 , 29 In a randomized non-inferiority trial, data supported a comparable analgesic effect to treat severe painful SC crisis between intravenous (i.v.) ketamine and equianalgesic i.v.…”

Section: Reviewmentioning

confidence: 99%

“… 28 A literature review highlighted the potential effectiveness of low-dose ketamine infusions for painful SC crisis on the reduction of pain score and opioid dosage ( Table 1 ). 29 …”

Section: Reviewmentioning

confidence: 99%

Refractory symptoms in paediatric palliative care: can ketamine help?

Benini¹,

Congedi²,

Giacomelli³

et al. 2021

DIC

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Background One of the main challenges for paediatric palliative care (PPC) is the management of concomitant, different and severe symptoms that frequently affect the quality of life of PPC patients and are often refractory to commonly used pharmacological treatments. Consequently, many efforts are still needed to find the best therapeutic options to handle these refractory conditions. Since the first synthesis of ketamine in the 1960s, its pharmacokinetic and pharmacodynamic properties have been largely investigated and its potential wide range of clinical applications has become clear. However, this molecule still receives poor attention in some areas, including in children and PPC. This narrative review analyses the use of ketamine in children and the potential extension of its applications in PPC in order to provide new options for treatment in the PPC setting. Methods Scientific papers published before October 2020 on MEDLINE, EMBASE and the Cochrane Library were considered. The cited references of the selected papers and the authors’ personal collections of literature were reviewed. The terms “palliative care”, “ketamine”, “neuropathic pain”, “procedural pain”, “status epilepticus”, “refractory pain” and “child”, adding “age: birth–18 years” on a further filter were used for the search. Discussion The use of ketamine in PPC should be more widely considered due to its overall favourable safety profile and its efficacy, which are supported by an increasing number of studies, although in settings different from PPC and of mixed quality. Ketamine should be proposed according to a case-by-case evaluation and the specific diagnosis and the dosage and route of administration should be tailored to the specific needs of patients. Furthermore, there is evidence to suggest that ketamine is safe and efficacious in acute pain. These findings can prompt further research on the use of ketamine for the treatment of acute pain in PPC. Conclusion Ketamine could be a suitable option after the failure of conventional drugs in the treatment of different refractory conditions in PPC.

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Ketamine Infusion for Pain Control in Acute Pediatric Sickle Cell Painful Crises

Abstract: Ketamine infusions have shown promise in assisting physicians in appropriately treating pediatric sickle cell painful crises.

Cited by 21 publications

References 28 publications

Impact of Ketamine in the Management of Painful Sickle Cell Disease Vaso-Occlusive Crisis

Impact of Ketamine in the Management of Painful Sickle Cell Disease Vaso-Occlusive Crisis

A systematic review of ketamine for the management of vaso‐occlusive pain in sickle cell disease

Refractory symptoms in paediatric palliative care: can ketamine help?

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