title: Ketamine PCA for treatment of end-of-life neuropathic pain in pediatrics.
abstract: Control of neuropathic pain (NP) for children at end of life is challenging. Ketamine improves control of NP, but its use in children is not well described. We describe a retrospective case review of 14 children with terminal prognoses treated with ketamine patient-controlled analgesia (PCA) for management of opioid-refractory NP at the end of life. Median ketamine dose was 0.06 mg/kg/h (range 0.014-0.308 mg/kg/h) with a 0.05 mg/kg (range 0.03-0.5mg/kg) demand dose available every 15 minutes (range 10-60 minutes). All patients noted subjective pain relief with ketamine, and 79% had no adverse effects. Benzodiazepines limited neuropsychiatric side effects. Ketamine treatment arrested dose escalation of opioids in 64% of patients, and 79% were discharged to home hospice. Ketamine PCA is an effective, well-tolerated therapy for opioid-refractory NP in pediatric end-of-life care.
authors.affiliation: Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Taylor
authors.affiliation: Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Children's Hospital of Pittsburgh of UPMC Supportive Care Program, Pittsburgh, PA, USA.
authors.forename: Regina
authors.initials: R
authors.lastname: Jakacki
authors.affiliation: Children's Hospital of Pittsburgh of UPMC Supportive Care Program, Pittsburgh, PA, USA.
authors.forename: Carol
authors.initials: C
authors.lastname: May
authors.affiliation: Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA.
authors.forename: Denise
authors.initials: D
authors.lastname: Howrie
authors.affiliation: Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Children's Hospital of Pittsburgh of UPMC Supportive Care Program, Pittsburgh, PA, USA Scott.maurer@chp.edu.
authors.forename: Scott
authors.initials: S
authors.lastname: Maurer
mesh_terms: D000293:Adolescent; D000700:Analgesics / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007649:Ketamine / Q000008:administration & dosage*; D008297:Male; D009437:Neuralgia / Q000188:drug therapy*; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000700:Analgesics; D007649:Ketamine
keywords: PCA; end of life; hospice; ketamine; neuropathic pain; pediatrics