Use of low-dose ketamine infusion for pediatric patients with sickle cell disease-related pain: a case series.
OBJECTIVE
Sickle cell disease-related pain is difficult to treat adequately. Pain secondary to vasoocclusive episodes (VOE) may be unresponsive to high-dose intravenous opiates. Alternative treatment options for VOE are needed. We sought to review our experience with low-dose ketamine for children hospitalized with VOE.


METHODS
Retrospective medical chart reviews were conducted for hospitalized patients treated with ketamine for sickle cell VOE. Data gathered included vital signs, pain scores, opiate utilization, and adverse events.


RESULTS
Five children and adolescents received a low-dose ketamine infusion for the treatment of sickle cell-related pain. Four received the infusion in addition to opiates (delivered via patient controlled analgesia) as a rescue intervention after several days of inadequate pain relief and 1 patient received ketamine in place of opiates. Two of the 5 patients achieved what seems to be clinically significant pain control with a low-dose ketamine infusion, whereas 1 additional patient had significant reduction in opiate utilization.


CONCLUSIONS
Further research into ketamine for vasoocclusive pain is warranted.
Zempsky
William T
WT
Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, CT, USA. wzempsk@ccmckids.org
Loiselle
Kristin A
KA
Corsi
John M
JM
Hagstrom
J Nathan
JN
D000293:Adolescent; D000700:Analgesics / Q000627:therapeutic use*; D000755:Anemia, Sickle Cell / Q000150:complications*; D002648:Child; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous / Q000379:methods; D007649:Ketamine / Q000627:therapeutic use*; D008297:Male; D010146:Pain / Q000188:drug therapy* / Q000209:etiology*; D010147:Pain Measurement; D012189:Retrospective Studies
D000700:Analgesics; D007649:Ketamine