Oral Ketamine for Children with Chronic Pain: A Pilot Phase 1 Study

Bredlau, Amy-Lee; McDermott, Michael P.; Adams, Heather; Dworkin, Robert H.; Venuto, Charles S.; Fisher, Susan G.; Korones, David N.

doi:10.1016/j.jpeds.2012.12.077

Cited by 38 publications

(32 citation statements)

References 24 publications

(27 reference statements)

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“…Its role as an analgesic has been well documented in various settings such as cancer or palliative care, perioperative care, and chronic therapy for neuropathic pain. [6][7][8][9][10][11][12][13] However, the use of ketamine for acute pain is not a common practice in the ED. Its use is often a topic of controversy due its ability to cause adverse events such as dissociation and emergence phenomena.…”

Section: Introductionmentioning

confidence: 99%

The Use of Subdissociative‐dose Ketamine for Acute Pain in the Emergency Department

Sin

Ternas

Motov

2015

Academic Emergency Medicine

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Objectives: Ketamine is a well-known anesthetic with its use trailing back to the 1960s. It has antagonistic effects at the N-methyl-D-aspartate receptor. There is emerging literature to suggest the use of subdissociative-dose ketamine (SDDK) for pain reduction. This evidence-based review evaluates the evidence regarding the use of SDDK for acute pain control in the emergency department (ED). Methods:The MEDLINE and EMBASE databases were searched. Randomized controlled trials (RCTs) that described or evaluated the use of SDDK for acute pain in the ED were included. Literature was excluded if it was not published in English. Duplicate articles, unpublished reports, abstracts, and review articles were also excluded. Quality assessment and evaluation of literature were evaluated based on the GRADE criteria. The primary outcome of interest in this review was the difference in pain score from baseline to cutoff time as specified in the studies. Secondary outcome measures were the incidence of adverse events and reduction in the amount of adjuvant opioids consumed by patients who received SDDK.Results: Four RCTs met the inclusion criteria, which enrolled a total of 428 patients. Three adult trials and one pediatric trial were identified. The level of evidence for the individual trials ranged from low to moderate. A significant reduction in pain scores was only found in two of the four trials. One trial found a significant reduction in mean pain scores when ketamine was compared to morphine (p < 0.05). Another trial reported a significant decrease in mean distress scores, favoring SDDK over fentanyl (1.0 vs. 2.7, p < 0.05). One trial found a significant reduction in the amount of morphine consumed, favoring ketamine over placebo (0.14 mg/kg, 95% confidence interval [CI] = 0.13 to 0.16 mg/kg vs. 0.2 mg/kg, 95% CI = 0.18 to 0.22 mg/kg; p < 0.001). An emergence phenomenon was reported in one trial.Conclusions: Four RCTs with methodologic limitations failed to provide convincing evidence to either support or refute the use of SDDK for acute pain control in the ED.ACADEMIC EMERGENCY MEDICINE 2015;22:251-257

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Section: Introductionmentioning

confidence: 99%

The Use of Subdissociative‐dose Ketamine for Acute Pain in the Emergency Department

Sin

Ternas

Motov

2015

Academic Emergency Medicine

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“…Inspiration was found in the literature where oral ketamine and midazolam was recommended, but also at a risk of long time consequences 11 12…”

Section: Discussionmentioning

confidence: 99%

Newborn with severe epidermolysis bullosa: to treat or not to treat?

et al. 2016

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Epidermolysis bullosa (EB) is an inherited skin disease with four main subtypes that cannot be distinguished clinically at birth. All subtypes may present with widespread life-threatening blisters and fragile skin, making treatment and handling of the newborn with EB challenging. The prognosis of EB depends on the subtype, and therefore maximum treatment is necessary until the final diagnosis is known. In this case, it took 2 weeks before a final diagnosis was reached. In the meantime, we had several ethical discussions on the treatment level. The most important issues were management of pain and nutrition. For immediate pain relief, intranasal fentanyl worked best and gabapentin was successfully used for chronic pain. The feeding difficulties were handled first by a nasogastric feeding tube. Later a normal feeding bottle proved to be adequate.

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“…There are a number of small case series that suggest that ketamine is a useful medication for the control of chronic pain in children. To date, however, there are few data that aid a pediatrician in determining if ketamine is a safe and effective option for children with cancer pain, whose brains are immature and whose metabolism is different from that of adults [18]. Finally, data on invasive procedures remain anecdotal, and precise indications on who should receive such treatments, when these should be performed, and how these should be administered remain unclear.…”

Section: Discussionmentioning

confidence: 99%