Pain management in fulminating ulcerative colitis.

Abstract

BACKGROUND:

Toxic megacolon is a life-threatening complication of ulcerative colitis (UC) characterized by systemic toxicity, loss of blood per rectum and severe pain. Pain management is challenging in these patients because nonsteroidal anti-inflammatory drugs may exacerbate bleeding and opioids are contraindicated because they adversely affect bowel peristalsis causing an increased risk of colonic perforation.

METHODS:

We describe three episodes of fulminating UC in two children in whom ketamine analgesia was used. Our protocol for a low-dose continuous ketamine infusion with either nurse-controlled analgesia (NCA) or patient-controlled analgesia (PCA) bolus administration is presented and a review of the literature regarding the use of ketamine analgesia in children is discussed.

RESULTS:

Low-dose ketamine N/PCA with a continuous background infusion provided satisfactory analgesia and none of our children reported adverse effects.

CONCLUSIONS:

We have demonstrated the safe and effective use of ketamine analgesia in children with toxic megacolon, a condition in which the child is in severe pain and morphine is contraindicated.

• Authors: Michelle White, Neil Shah, Keith Lindley, Adrian Lloyd-Thomas, Mark Thomas
• Journal: Paediatric anaesthesia (Paediatr Anaesth) Vol. 16 Issue 11 Pg. 1148-52 (Nov 2006) ISSN: 1155-5645 [Print] France
• PMID: 17040304 (Publication Type: Case Reports, Journal Article)

Chemical References

• Analgesics
• Analgesics, Opioid
• Ketamine
• Morphine

Topics

• Analgesia, Patient-Controlled
• Analgesics (administration & dosage, therapeutic use)
• Analgesics, Opioid
• Child
• Colitis, Ulcerative (complications)
• Contraindications
• Female
• Humans
• Ketamine (administration & dosage, therapeutic use)
• Male
• Megacolon, Toxic (complications)
• Morphine
• Pain (drug therapy, etiology)
• Pain Measurement