Efficacy and Safety of Ketamine Infusions in Pediatric Patients With Acute Pain Related to Sickle Cell Disease

Abstract

Background: When pain associated with sickle cell disease (SCD) escalates, adjunctive agents including ketamine are increasingly employed as part of multimodal pain management strategies. Ketamine enhances analgesic effects when used in conjunction with opioids, often allowing for reduced opioid requirements and mitigating associated adverse effects such as tolerance, dependence, and respiratory depression. In the adult population, subanesthetic ketamine infusions have been used in non-critical care settings as an adjunct to opioid analgesia.

Methods: We retrospectively reviewed our experience with the use of a ketamine infusion outside of the pediatric intensive care unit setting for complex pain uncontrolled by opioids related to SCD in pediatric-aged patients. The study cohort included patients ≤ 21 years of age who received continuous ketamine infusions for SCD-related pain over a 10-year period at a tertiary pediatric hospital.

Results: The study cohort included 51 patients and 141 hospitalizations, with ketamine initiated at a mean starting rate of 0.10 ± 0.03 mg/kg/h and administered for a median duration of 4 days. Adverse events occurred in 24 out of the 51 patients in the cohort during at least one hospitalization, resulting in infusion discontinuation in 12 patients. Hallucinations and dizziness were the most frequently reported events. Infusion discontinuation due to lack of efficacy occurred in seven patients.

Conclusions: Our findings demonstrate that, with standardized protocols, staff education, and appropriate monitoring, ketamine infusions can be safely administered outside of the intensive care unit for pediatric patients with SCD experiencing severe pain.