Calderon Martinez Ernesto, Zachariah Saji Stephin, Campos Carmona Thomas, Abbagoni Vaidarshi, Salman Mohammad, Llerena Vargas Mishell Estefanía, Mylavarapu Suchita, Fernando Druvini, Arvapalli Lakshmi Sheethal, Schettino Samad Nathalia, Karnan Nithin, Sanchez Cruz Camila
Biomedical Informatics Universidad Nacional Autónoma de México Mexico City Mexico.
Our Lady of Fatima University Valenzuela City Philippines.
EJHaem. 2024 Nov 25;5(6):1312-1321. doi: 10.1002/jha2.1050. eCollection 2024 Dec.
Sickle cell disease (SCD) is characterized by acute episodes called vaso-occlusive crises (VOC). VOC is marked by severe pain due to blocked blood vessels by sickled cells. Ketamine has been reported to be effective and safe in managing VOC in SCD patients.
OBJECTIVES/METHODS: This review aims to determine ketamine's safety and efficacy through analysis of clinical trials and observational studies.
Adhering to PRISMA guidelines, this systematic review and meta-analysis systematically searched seven databases on May 20, 2024 for randomized control trials (RCT), cohorts, and case-control studies.
Five studies with 689 participants met the inclusion criteria. A meta-analysis of two studies (518 observations) for the Numerical Rating Scale (NRS) pain score showed no significant difference, with a standardized mean difference (MD) of 0.23 (95% CI: -0.13 to 0.59, = 0.21, = 0%). For morphine milligram equivalent (MME), a meta-analysis of two studies (344 observations) resulted in an MD of -0.03 (95% CI: -0.09 to 0.04, = 0.45, = 97%). However, the side effects analysis from four studies (608 observations) showed a significantly higher relative risk (RR) of 5.74 (95% CI: 2.80-11.79, < 0.0001, = 0%) for mild side effects, including nausea, vomiting, and dizziness.
Ketamine qualitative synthesis shows potential for improving pain management in SCD patients during VOC, but without statistically significant differences in pain reduction. It is associated with increased mild side effects, though no severe adverse events were reported. Further research is needed to increase the sample size and power of the analysis to clarify optimal dosing and administration protocols for ketamine in this context.
镰状细胞病（SCD）的特征是出现称为血管闭塞性危机（VOC）的急性发作。VOC的特点是镰状细胞阻塞血管导致严重疼痛。据报道，氯胺酮在管理SCD患者的VOC方面有效且安全。
目的/方法：本综述旨在通过分析临床试验和观察性研究来确定氯胺酮的安全性和有效性。
遵循PRISMA指南，本系统综述和荟萃分析于2024年5月20日系统检索了七个数据库，以查找随机对照试验（RCT）、队列研究和病例对照研究。
五项研究共689名参与者符合纳入标准。对两项研究（518个观察值）的数字评分量表（NRS）疼痛评分进行的荟萃分析显示无显著差异，标准化平均差（MD）为0.23（95%CI：-0.13至0.59，P = 0.21，I² = 0%）。对于吗啡毫克当量（MME），两项研究（344个观察值）的荟萃分析得出MD为-0.03（95%CI：-0.09至0.04，P = 0.45，I² = 97%）。然而，四项研究（608个观察值）的副作用分析显示，包括恶心、呕吐和头晕在内的轻度副作用的相对风险（RR）显著更高，为5.74（95%CI：2.80 - 11.79，P < 0.0001，I² = 0%）。
氯胺酮的定性综合分析显示，在VOC期间改善SCD患者疼痛管理具有潜力，但在减轻疼痛方面无统计学显著差异。它与轻度副作用增加有关，尽管未报告严重不良事件。需要进一步研究以增加样本量和分析效能，以阐明在此背景下氯胺酮的最佳给药剂量和方案。
