St. Jude Children's Research Hospital, Memphis, Tennessee.
Loyola University Chicago Stritch School of Medicine, Maywood, Illinois.
Pediatr Blood Cancer. 2022 Sep;69(9):e29693. doi: 10.1002/pbc.29693. Epub 2022 Apr 4.
Ketamine is an NMDA-receptor antagonist with analgesic and opioid-sparing properties. Although well studied in adults, more robust evidence supporting ketamine's use for pediatric pain management is needed. This retrospective study evaluates ketamine's opioid-sparing effectiveness in pediatric and young adult oncology and hematology patients.
Continuous ketamine infusions administered for pain management between 2010-2020 were reviewed. Data including demographic characteristics, oncology/hematology and pain diagnoses, concurrent pain medications, and ketamine infusions' dose and duration were collected. Opioid consumption data based on delivery via patient-controlled analgesia were collected 1 day before (D1), all days during (cumulatively named D2), and 1 day after (D3) ketamine infusions and calculated as morphine-equivalent doses (mg/kg/day). Data were reported for the entire study group as well as for distinct oncology and end-of-life categories, and short-term acute pain circumstances which included vaso-occlusive crises in hematology patients. Side effects were reviewed.
Significantly lower daily opioid consumption was noted in the oncology group, while decreases were not significant in the end-of-life group and in the overall study population. The acute pain group did not show an opioid reduction associated with the ketamine infusions. A largely tolerable side-effect profile was observed, with no differences among each group's incidence.
Ketamine infusions were associated with significantly reduced opioid consumption for oncology patients. The opioid-sparing effects of ketamine may vary according to clinical diagnoses and circumstances of use. Overall, low-dose ketamine infusions present an acceptable safety profile in pediatric and young adult patients; nevertheless, individual risks and benefits should be considered.
氯胺酮是一种 NMDA 受体拮抗剂，具有镇痛和减少阿片类药物的作用。尽管在成人中得到了充分的研究，但仍需要更有力的证据来支持氯胺酮在儿科疼痛管理中的应用。本回顾性研究评估了氯胺酮在儿科和年轻成年肿瘤科和血液科患者中的镇痛效果。
回顾了 2010 年至 2020 年间用于疼痛管理的连续氯胺酮输注。收集的数据包括人口统计学特征、肿瘤学/血液学和疼痛诊断、同时使用的疼痛药物以及氯胺酮输注的剂量和持续时间。根据患者自控镇痛（PCA）给药的阿片类药物消耗数据，在输注前 1 天（D1）、所有输注日（统称 D2）和输注后 1 天（D3）进行收集，并计算为吗啡等效剂量（mg/kg/天）。数据报告了整个研究组以及特定的肿瘤学和临终关怀类别，以及包括血液科患者血管阻塞性危象在内的短期急性疼痛情况。审查了副作用。
在肿瘤学组中，每日阿片类药物消耗明显降低，而在临终关怀组和整个研究人群中，这种降低并不显著。急性疼痛组没有显示与氯胺酮输注相关的阿片类药物减少。观察到的副作用谱大多可以耐受，各组的发生率没有差异。
氯胺酮输注与肿瘤患者阿片类药物消耗的显著减少相关。氯胺酮的镇痛效果可能因临床诊断和使用情况而异。总体而言，小剂量氯胺酮输注在儿科和年轻成年患者中具有可接受的安全性；然而，应考虑个体风险和收益。
