Treatment of Severe Mucositis Pain with Oral Ketamine Mouthwash

Abstract

Results: 97 allo HSCT patients were enrolled between 7/ 2013-9/2014 and were discharged with a mean of 14 medications. Pharmacists completed 134 interventions; 80% of patients required at least 1 pharmacist intervention. Median time to complete medication reconciliation, interventions, and education was 52 (IQR 25-105) minutes. 90% of patients were able to describe 2 or 3 of the following concepts: how to take their medications, administration instructions, and what to do with missed doses. 77% of patients were able to explain the indications of each medication; while only 30% could list all clinically relevant side effects for their medications. Encouragingly, 76% of patients knew their dose of tacrolimus and reported and an overall compliance of 98%. Level of education, marital status, co-morbidities, and medication availability are potentially associated with patient education outcomes, which provide areas of improvement in the process. Conclusions: The majority of HSCT patients required some form of a pharmacist intervention during discharge medication reconciliation. Pharmacist helped to improve the transition of care at discharge for HSCT patients by improving patient understanding of their medications, medication adherence, and accuracy of patient medication lists

Ketamine mouthwash versus placebo in the treatment of severe oral mucositis pain in children with cancer: A randomized double‐blind placebo‐controlled trial

“…There are noticeable differences in the patient profile and the study design in the previous studies as compared with the current study. A pain reduction of 1.64 points on the 6‐point scale in the current study was comparable with the pain reduction of two points on a 10‐point scale at 1 hour of drug administration in the study carried out by Shillingburg et al, 13 but it carries little significance as the placebo arm also demonstrated a pain reduction of 1.32 points on the 6‐point scale in the current study.…”

“…Based on the study by Shillingburg et al, 13 assuming a mean pain score reduction of three points in the intervention group and two points in the control group, with a standard deviation (SD) of 1, level of confidence 95%, and power 90%, a sample size of 44 patients (22 in each arm) was determined and targeted for accrual, based on the two‐sample t test with an equal‐variance assumption. Because of the short follow‐up period (four hours), no additional patients were targeted for enrolment.…”

“…Topical ketamine has also been found to be a safe and effective analgesic for decreasing post‐tonsillectomy pain in children 11,12 . Ketamine oral rinse has shown promising results in a few nonrandomized studies in adults with chemotherapy‐related OM pain 13‐15 . This randomized, double‐blind placebo‐controlled trial aimed to test the efficacy of ketamine mouthwash in the reduction of chemotherapy‐induced severe OM (WHO grade III or grade IV) pain.…”

Incidence of and risk factors for development of oral mucositis in outpatients undergoing cancer chemotherapy

“…The WHO Mucositis Grading Scale is a simple, easy‐to‐use measure that is often preferred in studies and suitable for daily use in clinical practice (Hosseinjani et al, ; Shillingburg et al, ; Vagliano et al, ). The WHO rating scale measures oral mucositis in terms of its anatomical, symptomatic, and functional components.…”

A review of the clinical applications of ketamine in pediatric oncology

“…24,89,90 Preliminary evidence for ketamine mouthwash for oral mucositis pain had suggested a beneficial role in adults. [91][92][93] However, a recent RCT by Prakash et al (from author's center) evaluating the role of ketamine mouthwash for oral mucositis pain relief in children (n = 44; 8-18 years) with cancer found ketamine to be ineffective at a dose of 1 mg/kg. 94 TA B L E 3 Prospective trials of ketamine for procedural pain or sedation in children with cancer (sample size ≥ 10) and decreased risk of abuse or dependence.…”