Low‐dose ketamine infusions reduce opioid use in pediatric and young adult oncology patients. Issue 9 (4th April 2022)

• Record Type: Journal Article
• Authors: Anghelescu, Doralina L; Ryan, Stephanie; Wu, Diana; Morgan, Kyle J.; Patni, Tushar; Li, Yimei
• Is Part Of: Pediatric blood & cancer. Volume 69:Issue 9(2022)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2022-04-04
• Subjects: Hematology -- ketamine -- oncology -- opioid -- pediatric; Tumors in children -- Periodicals; Blood -- Diseases -- Periodicals; Cancer in children -- Periodicals; 618.92
• DOI: 10.1002/pbc.29693
• Languages: English
• ISSNs: 1545-5009

Abstract

Abstract: Background: 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. Procedure: 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. Results: 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. Conclusions: 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.