Ketamine and lidocaine infusions decrease opioid consumption during vaso-occlusive crisis in adolescents with sickle cell disease

Abstract

Purpose of reviewRecurrent exposure to opioids can lead to development of opioid tolerance and opioid-induced hyperalgesia through activation of N-methyl-D-aspartate receptors. N-methyl-D-aspartate receptor antagonists ketamine and lidocaine can modulate development of opioid tolerance and OIH. This study evaluated the utility of ketamine and/or lidocaine in decreasing opioid consumption during acute pain episodes in adolescents with sickle cell disease. There has been an increased effort to promote opioidsparing pain relieving methods given the ongoing opioid epidemic. Recent findingsThere have been six studies published over the past decade that highlight the ability of ketamine to reduce opioid consumption in the management of sickle cell disease-related pain, primarily in adult patients. There has been one study (2015) that demonstrated a similar benefit with lidocaine, however this was also in adult patients.

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

“…Side effects are not mentioned. 41 Ketamine as a bolus has also been a strategy used to treat acute VOE in the emergency department (ED). Lubega et al performed a prospective, double-blind, active-control, noninferiority trial that randomized 240 children with severe painful SCD crisis to receive either i.v.…”

“…Three patients had reduced daily opioid consumption during the admissions when ketamine was added to treatment. Side effects are not mentioned 41 …”

Opioid Use in Adults With Sickle Cell Disease Hospitalized During Vaso-Occlusive Crisis: A Systematic Review

“…Non-addictive alternatives can potentially relieve the stigma associated with opioid use in the SCD population. Researchers evaluated two such non-addictive alternatives, ketamine and/or lidocaine via IV infusion in adolescents hospitalized secondary to VOC [ 43 ]. Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist which delivers analgesic effects [ 44 ], and has been shown to reduce opioid consumption in a small sample of adolescents hospitalized secondary to VOC [ 43 ].…”

“…Researchers evaluated two such non-addictive alternatives, ketamine and/or lidocaine via IV infusion in adolescents hospitalized secondary to VOC [ 43 ]. Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist which delivers analgesic effects [ 44 ], and has been shown to reduce opioid consumption in a small sample of adolescents hospitalized secondary to VOC [ 43 ]. Lidocaine is an amide local anesthetic used for pain control in various diseases and circumstances [ 43 ].…”

“…Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist which delivers analgesic effects [ 44 ], and has been shown to reduce opioid consumption in a small sample of adolescents hospitalized secondary to VOC [ 43 ]. Lidocaine is an amide local anesthetic used for pain control in various diseases and circumstances [ 43 ]. Lidocaine, like ketamine, is an NMDA receptor antagonist that delivers an anti-hyperalgesic influence and consequently relieves pain [ 45 ].…”