title: Pain management in fulminating ulcerative colitis.
abstract: BACKGROUND
  Toxic megacolon is a life-threatening complication of ulcerative colitis (UC) characterized by systemic toxicity, loss of blood per rectum and severe pain. Pain management is challenging in these patients because nonsteroidal anti-inflammatory drugs may exacerbate bleeding and opioids are contraindicated because they adversely affect bowel peristalsis causing an increased risk of colonic perforation.
  
  
  METHODS
  We describe three episodes of fulminating UC in two children in whom ketamine analgesia was used. Our protocol for a low-dose continuous ketamine infusion with either nurse-controlled analgesia (NCA) or patient-controlled analgesia (PCA) bolus administration is presented and a review of the literature regarding the use of ketamine analgesia in children is discussed.
  
  
  RESULTS
  Low-dose ketamine N/PCA with a continuous background infusion provided satisfactory analgesia and none of our children reported adverse effects.
  
  
  CONCLUSIONS
  We have demonstrated the safe and effective use of ketamine analgesia in children with toxic megacolon, a condition in which the child is in severe pain and morphine is contraindicated.
authors.affiliation: United Bristol Health Care Trust, Bristol, UK. mcwdoc@doctors.org.uk
authors.forename: Michelle
authors.initials: M
authors.lastname: White
authors.forename: Neil
authors.initials: N
authors.lastname: Shah
authors.forename: Keith
authors.initials: K
authors.lastname: Lindley
authors.forename: Adrian
authors.initials: A
authors.lastname: Lloyd-Thomas
authors.forename: Mark
authors.initials: M
authors.lastname: Thomas
mesh_terms: D016058:Analgesia, Patient-Controlled; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use*; D000701:Analgesics, Opioid; D002648:Child; D003093:Colitis, Ulcerative / Q000150:complications*; D000075202:Contraindications; D005260:Female; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008532:Megacolon, Toxic / Q000150:complications*; D009020:Morphine; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D007649:Ketamine; D009020:Morphine