Low-Dose Oral Ketamine for Procedural Analgesia in Pediatric Cancer Patients Undergoing Lumbar Puncture at a Resource-Limited Cancer Hospital in India

Rayala, Spandana; Bäckdahl, Tim; Reddy, N. Subbarami; Jacob, Jean Daniel; Gebre-Medhin, Erik; Karonen, Emil; Palat, Gayatri; Sinha, Sudha; Schyman, Tommy; Wiebe, Thomas; Brun, Eva; Segerlantz, Mikael

doi:10.1089/jpm.2018.0667

Cited by 5 publications

(5 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the present study, we found no significant effects on the procedural pain during BMA whether placebo, ketamine, or ketamine with an addition of midazolam were administered. This in contrast to our previous study, Rayala et al .,[25] in which significantly reduced procedural pain was seen in patients undergoing LPs receiving oral ketamine, even in a dose lower than in the present study, and compared to patients receiving only local analgesia. No significant side-effects were seen in this study.…”

Section: Discussioncontrasting

confidence: 99%

“…The lack of effect in the present study, in contrast to Rayala et al .,[25] may be contributed to several differences between the studies. First, the study by Rayala et al .…”

Section: Discussioncontrasting

confidence: 99%

“…In a placebo-controlled study, we have shown that low-dose oral ketamine, at a dose of 0.8 mg/kg body weight is a feasible and effective analgesic for pediatric cancer patients undergoing lumbar punctures (LPs). [25] Thus, the present study continued the previous work on pain-management with low-dose oral ketamine for procedural pain in pediatric cancer patients in a low-resource hospital at a LMIC.…”

Section: Introductionsupporting

confidence: 53%

“…In the earlier mentioned study on LPs[26] this procedure was performed by familiar doctors in a well-known environment at the pediatric ward and with the caretaker close and present. [25]…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

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

Rayala

Kyander

Haridass

et al. 2019

Indian J Palliat Care

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Discussioncontrasting

confidence: 99%

“…The lack of effect in the present study, in contrast to Rayala et al .,[25] may be contributed to several differences between the studies. First, the study by Rayala et al .…”

Section: Discussioncontrasting

confidence: 99%

Section: Introductionsupporting

confidence: 53%

“…In the earlier mentioned study on LPs[26] this procedure was performed by familiar doctors in a well-known environment at the pediatric ward and with the caretaker close and present. [25]…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Rayala

Kyander

Haridass

et al. 2019

Indian J Palliat Care

Self Cite

View full text Add to dashboard Cite

show abstract

“…A common practice is to induce general anaesthesia but this possibility is not always available or the best option. 30 Due to its sedative and analgesic potential when used after trauma or surgery, 31 ketamine could be used in children for this purpose and its use is now accepted in this setting. 32 – 34 …”

Section: Reviewmentioning

confidence: 99%

Refractory symptoms in paediatric palliative care: can ketamine help?

Benini¹,

Congedi²,

Giacomelli³

et al. 2021

DIC

View full text Add to dashboard Cite

Background One of the main challenges for paediatric palliative care (PPC) is the management of concomitant, different and severe symptoms that frequently affect the quality of life of PPC patients and are often refractory to commonly used pharmacological treatments. Consequently, many efforts are still needed to find the best therapeutic options to handle these refractory conditions. Since the first synthesis of ketamine in the 1960s, its pharmacokinetic and pharmacodynamic properties have been largely investigated and its potential wide range of clinical applications has become clear. However, this molecule still receives poor attention in some areas, including in children and PPC. This narrative review analyses the use of ketamine in children and the potential extension of its applications in PPC in order to provide new options for treatment in the PPC setting. Methods Scientific papers published before October 2020 on MEDLINE, EMBASE and the Cochrane Library were considered. The cited references of the selected papers and the authors’ personal collections of literature were reviewed. The terms “palliative care”, “ketamine”, “neuropathic pain”, “procedural pain”, “status epilepticus”, “refractory pain” and “child”, adding “age: birth–18 years” on a further filter were used for the search. Discussion The use of ketamine in PPC should be more widely considered due to its overall favourable safety profile and its efficacy, which are supported by an increasing number of studies, although in settings different from PPC and of mixed quality. Ketamine should be proposed according to a case-by-case evaluation and the specific diagnosis and the dosage and route of administration should be tailored to the specific needs of patients. Furthermore, there is evidence to suggest that ketamine is safe and efficacious in acute pain. These findings can prompt further research on the use of ketamine for the treatment of acute pain in PPC. Conclusion Ketamine could be a suitable option after the failure of conventional drugs in the treatment of different refractory conditions in PPC.

show abstract

A review of the clinical applications of ketamine in pediatric oncology

Prakash

Gupta

Meena

et al. 2020

Pediatric Blood & Cancer

View full text Add to dashboard Cite

Ketamine is a dissociative anesthetic agent with excellent analgesic properties and a favorable safety profile. The feasibility and efficacy of various routes of administration have been established, including intravenous (IV), intramuscular (IM), oral, intranasal, rectal, and transdermal routes. The advent of newer anesthetic agents has led to a decline in the use of ketamine as an anesthetic, but its utility in short-term sedation and analgesia has expanded. Its value for chronic pain management in children with cancer is being increasingly recognized but requires more evidence. The use of topical ketamine is largely in investigational stages. Medical use of ketamine is, to a great extent, free from significant long-term neurological side effects. The objective of this review is to provide a brief account of the pharmacology of ketamine and primarily focus on the clinical applications of ketamine in pediatric oncology.

show abstract

Low-Dose Oral Ketamine for Procedural Analgesia in Pediatric Cancer Patients Undergoing Lumbar Puncture at a Resource-Limited Cancer Hospital in India

Cited by 5 publications

References 17 publications

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

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

Refractory symptoms in paediatric palliative care: can ketamine help?

A review of the clinical applications of ketamine in pediatric oncology

Contact Info

Product

Resources

About