Low-dose oral ketamine as a procedural analgesia in pediatric cancer patients undergoing bone marrow aspirations at a resource-limited cancer hospital in India

Abstract

Aim:Many pediatric cancer patients undergo repeated bone marrow aspirations (BMAs) for diagnostic and treatment evaluation purposes. Full anesthesia is the standard of care during this procedure in high-income countries. At hospitals with low resources in low/middle-income countries many children undergo these painful procedures without sufficient pain relief. This study aimed to evaluate the usefulness of low-dose oral ketamine as a procedural analgesic in a low-resource pediatric cancer care department.Materials and Methods:Pediatric patients, 4–15 years of age, who underwent BMAs between September 31 and November 30, 2018, were invited to participate. The study was designed as a placebo-controlled, single-blinded trial with three trial groups. Group K received 1.0 mg/kg of ketamine and Group KM received 1.0 mg/kg ketamine with an addition of 0.2 mg/kg midazolam, mixed in juice 30 min before procedures. Group P received placebo consisting of plain juice. All three groups also received the hospital's current standard treatment for procedural pain in BMAs. Patients and caregivers assessed the procedural pain, as did the performing doctors. For the patients, Faces Pain Scale – Revised was used and the Numeric Rating Scale-11 for caregivers and doctors.Results:A total of 87 patients were included in the study distributed with 29 in Group K, 29 in Group KM, and 29 in Group P. Seven patients were excluded, one patient denied participation and the remaining did not meet the inclusion criteria. There was no significant difference between the pain reported by the groups. A total of 69% patients in Group KM and 35% in Group K had somnolence reported as a side effect compared to 14% in Group P.Conclusion:We found no significant effects on the procedural pain in any of the treatment groups compared to placebo. There were only mild side effects. The doses of ketamine might be insufficient for this painful and stressful procedure.

The effect of music on comfort, pain, and anxiety in patients with bone marrow aspiration and biopsy in Turkey: a mixed-methods study

“…Although complication rates are low in bone biopsy/aspiration procedures, patients experience pain [ 34 ]. The literature shows that reported pain scores for BMAB range from 3.2 to 4 on a 10-point scale [ 2 , 6 ]. In their study, Jaddini et al(2016) reported that patients’ pain levels were high during the BMAB procedure [ 4 ].…”

“…Yayla et al (2019) reported that 55–70% of the patients undergoing these procedures described BMAB as a painful process [ 5 ]. The literature states that pain scores reported for BMAB range from 3.2 to 4 on a 10-point scale [ 2 , 6 ]. At the same time, it was found that patients experience anxiety due to the pain experienced as a result of BMAB procedures [ 7 ].…”

Refractory symptoms in paediatric palliative care: can ketamine help?

“…These studies were conducted in a resource-limited hospital setting and, according to the results, oral ketamine could be defined as an option for lumbar puncture; bone marrow aspiration is defined as a painful and stressful procedure and oral ketamine is not sufficient. 47 , 48 …”