Graduate Medical Education.
University of California Berkeley, Berkeley, CA.
J Pediatr Hematol Oncol. 2022 Jan 1;44(1):e188-e193. doi: 10.1097/MPH.0000000000002290.
Management of refractory pain in pediatric sickle cell disease (SCD) and oncology is reliant on opioids though high opioid dosing increases side effects and tachyphylaxis. We introduced low-dose ketamine infusion (LDKI) to our inpatient unit to determine if LDKI was tolerable. We subsequently hypothesized that LDKI would improve pain scores. We reviewed inpatients from LDKI initiation in March 2014 through October 2017, with the day before LDKI initiation compared with the day of LDKI initiation and 2 subsequent days. For patients with SCD, the LDKI admission was compared with up to 3 admissions in the prior year for a vaso-occlusive event. Nineteen patients (12 oncology, 7 SCD) with a median age of 14.6 years received LDKI for a median of 6 days at a median initial dose of 0.06 mg/kg/h (1.1 µg/kg/min). There was no change in pain scores or opioid utilization when comparing the day before LDKI initiation with subsequent days. No patient discontinued LDKI because of intolerability. For patients with SCD, there was a median 32% reduction in cumulative pain scores when comparing the LDKI admission with prior admissions. LDKI is well tolerated for refractory pediatric cancer-related and sickle cell-related pain.
在小儿镰状细胞病（SCD）和肿瘤学中，难治性疼痛的管理依赖于阿片类药物，尽管高剂量阿片类药物会增加副作用和快速耐受。我们在住院病房中引入了小剂量氯胺酮输注（LDKI），以确定 LDKI 是否可耐受。随后我们假设 LDKI 将改善疼痛评分。我们回顾了 2014 年 3 月至 2017 年 10 月 LDKI 开始使用以来的住院患者，比较了 LDKI 开始前一天与 LDKI 开始当天和随后两天的情况。对于 SCD 患者，将 LDKI 入院与前一年中最多 3 次血管阻塞事件入院进行比较。19 名患者（12 名肿瘤患者，7 名 SCD 患者），中位年龄为 14.6 岁，接受 LDKI 治疗，中位持续时间为 6 天，中位初始剂量为 0.06mg/kg/h（1.1μg/kg/min）。在比较 LDKI 开始前一天与随后几天时，疼痛评分或阿片类药物的使用没有变化。没有患者因不耐受而停止 LDKI。对于 SCD 患者，与之前的入院相比，LDKI 入院时的累积疼痛评分中位数降低了 32%。LDKI 可耐受小儿癌症相关和镰状细胞相关疼痛。
