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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.