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Use of Low-dose Ketamine Infusion for Pediatric Patients With Sickle Cell Disease-related Pain: A Case Series

Zempsky, William T. MD* †; Loiselle, Kristin A. BS*; Corsi, John M. BS, MBA*; Hagstrom, J. Nathan MD* †

doi: 10.1097/AJP.0b013e3181b511ab
Case Reports

Objectives: 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.

Discussion: Further research into ketamine for vasoocclusive pain is warranted.

*Connecticut Children's Medical Center

Department of Pediatrics, University of Connecticut School of Medicine, Hartford, CT

Supported by the Patrick and Catherine Weldon Donaghu Medical Research Foundation, West Hartford, CT.

Reprints: William T. Zempsky, MD, Connecticut Children's Medical Center, 282 Washington Street, Suite 5 G, Hartford, CT 06106 (e-mail: wzempsk@ccmckids.org).

Received for publication December 5, 2008

revised June 23, 2009

accepted June 26, 2009

© 2010 Lippincott Williams & Wilkins, Inc.