Acute pain episodes associated with sickle cell disease (SCD) are very difficult to manage effectively. Opioid tolerance and side effects have been major roadblocks in the ability to provide these patients with adequate pain relief. Lower doses of ketamine can reduce pain which may be useful in treating sickle cell related pain.
By Felix Lubega
Sickle cell disease is a major disease of public health concern and a significant contributor to mortality and morbidity in children under five in Uganda. The disease is distributed at different prevalence in all regions of the country.
When Uganda’s had a population of 25 million people, approximately 25,000 babies were being born with sickle cell disease annually. The population is now almost double and the standards of medical care have improved. With the prevailing medical care, it can be inferred that many more children are born with sickle cell and many are living beyond two years. Many have to endure the painful crises associated with the disease.
Vaso-occlusive crisis (VOC) is a painful complication and the hallmark of sickle cell disease (SCD) with an unpredictable onset that varies in frequency and intensity. It accounts for 90% of a sickler’s admission into day care centers with eventual hospital admission. Among these patients, 70% are associated with unmanageable pain that is often undertreated which leads to increased morbidity and mortality in this patient population.
Administered at sub-anesthetic doses, ketamine has been used to manage pain in a wide range of surgeries, for pediatric burns dressing change and cancer related pain. However, data on its use and safety in sickle cell crises in children has not been evaluated.
In their research paper published in the Scandinavian Journal of Pain, Ugandan clinicians describe a randomised trial aimed to compare the pain scores in children between 7 and 18 receiving low doses of ketamine with children receiving low doses of morphine.
Of the 240 patients that took part in the study, low-dose ketamine was found to be comparable to morphine in the pain scores. On a plus side, ketamine was shown to achieve maximum reduction in pain scores in a relatively shorter time than morphine – with the average duration of 60 minutes. On the negative side, low-dose ketamine patients were more likely to develop side effects, though these were transient and non-life threatening.
The clinicians state that further studies on the optimal infusion rate for ketamine to minimize side effects are required.
Read the original article here
Felix Anthony Lubega, Mithrika S. DeSilva, Deogratias Munube, Rita Nkwine, Janat Tumukunde, Peter K. Agaba, Mary T. Nabukenya, Fred Bulamba, Tonny S. Luggya: Low dose ketamine versus morphine for acute severe vaso occlusive pain in children: a randomized controlled trial. 14.02.2018