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

Harris, Emily M.; Vilk, Emily; Heeney, Matthew M.; Solodiuk, Jean C.; Greco, Christine; Archer, Natasha M.

doi:10.1002/pbc.28989

Cited by 6 publications

(12 citation statements)

References 47 publications

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“…Ketamine's ability to reduce opioid tolerance, central sensitization, and opioid‐induced hyperalgesia makes it an effective adjunct therapy in pediatric oncology and hematology patients, who may undergo prolonged opioid exposure 1,12 . In this study, many patients had a chronic opioid therapy diagnosis, and several were opioid‐tolerant.…”

Section: Discussionmentioning

confidence: 87%

“…Ketamine's ability to reduce opioid tolerance, central sensitization, and opioid-induced hyperalgesia makes it an effective adjunct therapy in pediatric oncology and hematology patients, who may undergo prolonged opioid exposure. 1,12 In this study, many patients had a chronic opioid therapy diagnosis, and several were opioid-tolerant. These findings are aligned with the accepted clinical practice strategies of adding ketamine to complex pain management regimens, which often rely on chronic opioid therapy.…”

Section: Discussionmentioning

confidence: 96%

“…Although used in various clinical settings, ketamine is especially effective in reducing pain in patients with cancer or sickle cell disease (SCD). 5,9,11,12 Despite substantial literature supporting ketamine's use for pain management in adults, studies in the pediatric population are relatively scarce, 1,5,[13][14][15] with most studies yielding promising results yet calling for further investigation of ketamine's safety, efficacy, and standardization of use. 2,5,6,[11][12][13][14] Ketamine's opioid-sparing effects in pediatric patients are not well demonstrated, with the few available studies reporting conflicting results.…”

Section: Introductionmentioning

confidence: 99%

“…5,9,11,12 Despite substantial literature supporting ketamine's use for pain management in adults, studies in the pediatric population are relatively scarce, 1,5,[13][14][15] with most studies yielding promising results yet calling for further investigation of ketamine's safety, efficacy, and standardization of use. 2,5,6,[11][12][13][14] Ketamine's opioid-sparing effects in pediatric patients are not well demonstrated, with the few available studies reporting conflicting results. 1,5,12,13,[15][16][17][18][19][20][21][22] With reduction of opioid exposure being a substantial consideration in developing complex pain management plans, more definitive findings regarding ketamine's use are essential to defining its place in pain treatment algorithms.…”

Section: Introductionmentioning

confidence: 99%

“…2,5,6,[11][12][13][14] Ketamine's opioid-sparing effects in pediatric patients are not well demonstrated, with the few available studies reporting conflicting results. 1,5,12,13,[15][16][17][18][19][20][21][22] With reduction of opioid exposure being a substantial consideration in developing complex pain management plans, more definitive findings regarding ketamine's use are essential to defining its place in pain treatment algorithms. 6,8,9,11 Our study presents a comprehensive retrospective investigation of ketamine's safety and efficacy in treating intractable pain in the pediatric oncology and hematology populations.…”

Section: Introductionmentioning

confidence: 99%

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Low‐dose ketamine infusions reduce opioid use in pediatric and young adult oncology patients

Anghelescu

Ryan

et al. 2022

Pediatric Blood & Cancer

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Background: Ketamine is an NMDA-receptor antagonist with analgesic and opioidsparing properties. Although well studied in adults, more robust evidence supporting ketamine's use for pediatric pain management is needed. This retrospective study evaluates ketamine's opioid-sparing effectiveness in pediatric and young adult oncology and hematology patients.Procedure: Continuous ketamine infusions administered for pain management between 2010-2020 were reviewed. Data including demographic characteristics, oncology/hematology and pain diagnoses, concurrent pain medications, and ketamine infusions' dose and duration were collected. Opioid consumption data based on delivery via patient-controlled analgesia were collected 1 day before (D1), all days during (cumulatively named D2), and 1 day after (D3) ketamine infusions and calculated as morphine-equivalent doses (mg/kg/day). Data were reported for the entire study group as well as for distinct oncology and end-of-life categories, and short-term acute pain circumstances which included vaso-occlusive crises in hematology patients. Side effects were reviewed.Results: Significantly lower daily opioid consumption was noted in the oncology group, while decreases were not significant in the end-of-life group and in the overall study population. The acute pain group did not show an opioid reduction associated with the ketamine infusions. A largely tolerable side-effect profile was observed, with no differences among each group's incidence.Conclusions: Ketamine infusions were associated with significantly reduced opioid consumption for oncology patients. The opioid-sparing effects of ketamine may vary according to clinical diagnoses and circumstances of use. Overall, low-dose ketamine infusions present an acceptable safety profile in pediatric and young adult patients; nevertheless, individual risks and benefits should be considered.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Low‐dose ketamine infusions reduce opioid use in pediatric and young adult oncology patients

Anghelescu

Ryan

et al. 2022

Pediatric Blood & Cancer

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Ketamine use for management of vaso‐occlusive pain in pediatric sickle cell disease

Harris

Vilk

Donado

et al. 2023

Pediatric Blood & Cancer

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Background Typical sickle cell disease (SCD) vaso‐occlusive pain episode (VOE) management includes opioids, which are often inadequate and can be associated with significant side effects. Ketamine, a dissociative anesthetic, is a potentially effective adjunct to VOE management. Objectives This study aimed to characterize ketamine use for VOE management in pediatric SCD. Method This retrospective case series summarizes a single‐center experience regarding the use of ketamine for inpatient management of pediatric VOE in 156 admissions from 2014 to 2020. Results Continuous low‐dose ketamine infusion was most commonly prescribed to adolescents and young adults as an adjunct to opioids (median starting dose 2.0 μg/kg/min; median maximum dose 3.0 μg/kg/min). Ketamine was started a median of 13.7 hours after admission. Median ketamine infusion duration was 3 days. In most encounters, ketamine infusion was discontinued prior to opioid patient‐controlled analgesia (PCA) discontinuation. The majority of encounters (79.3%) had a reduction in either PCA dose, continuous opioid infusion, or both while receiving ketamine. Low‐dose ketamine infusion was associated with side effects noted in 21.8% (n = 34) of encounters. The most common side effects included dizziness (5.6%), hallucinations (5.1%), dissociation (2.6%), and sedation (1.9%). There were no reports of ketamine withdrawal. Most patients who received ketamine went on to receive it again during a subsequent admission. Conclusion Further study is needed to determine the optimal timing of ketamine initiation and dosing. The variability of ketamine administration highlights the need for standardized protocols for ketamine use in VOE management.

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Novel uses of ketamine in the emergency department

Corwell

Motov

Davis

et al. 2022

Expert Opinion on Drug Safety

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

Cited by 6 publications

References 47 publications

Low‐dose ketamine infusions reduce opioid use in pediatric and young adult oncology patients

Low‐dose ketamine infusions reduce opioid use in pediatric and young adult oncology patients

Ketamine use for management of vaso‐occlusive pain in pediatric sickle cell disease

Novel uses of ketamine in the emergency department

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