Ketamine infusion for sickle cell pain crisis refractory to opioids: a case report and review of literature.

Abstract

This article reports a rare case of the use of low-dose ketamine infusion as an adjuvant to opioids to treat pain in sickle cell disease. A 31-year-old African-American male with history of sickle cell disease presented to the emergency department with complaints of chest tightness, multiple joint pain, and headache for 1 week. His vital signs and physical examination were unremarkable. His admission lab included hemoglobin of 8.4 g/dl, reticulocyte count of 16.3%, bilirubin of 1.7 mg/dl, and LDH of 1,267 U/l. Chest X-ray showed middle and lower lobe opacity and interstitial thickening. He was treated for acute pain crisis and community-acquired pneumonia with intravenous fluids, supplemental oxygen, and intravenous levofloxacin. He was placed on fentanyl patient-controlled analgesia (PCA), oxycodone, ketorolac, and methadone with co-analgesic gabapentin and venlafaxine. Over the course of his hospitalization, his chest pain resolved, but the joint pains continued. He was then transferred to the ICU and was discharged a day later after 7 days of ketamine infusion. Ketamine is a noncompetitive antagonist at the N-methyl-D-aspartate (NMDA) receptor. This property has been shown to modulate opioid tolerance and opioid-induced hyperalgesia. There have been a very few published reports on the use of low-dose ketamine in sickle cell pain management. A PubMed search revealed four published articles (Table 1). Fourteen out of the 17 cases (82.35%) who received ketamine infusion showed improvement in self-reported pain intensity and significant reduction in opioid dosage. Only one patient (5.9%) developed serious side effect leading to discontinuation of the drug. A low-dose ketamine can be an option for pain control in sickle cell disease. Randomized trial is required to establish this benefit of ketamine over currently available therapies.

• Authors: Dipesh Uprety, Aurangzeb Baber, Maria Foy
• Journal: Annals of hematology (Ann Hematol) Vol. 93 Issue 5 Pg. 769-71 (May 2014) ISSN: 1432-0584 [Electronic] Germany
• PMID: 24232306 (Publication Type: Case Reports, Journal Article, Review)

Chemical References

• Analgesics, Opioid
• Ketamine

Topics

• Adult
• Analgesics, Opioid (administration & dosage)
• Anemia, Sickle Cell (complications, drug therapy)
• Humans
• Infusions, Intravenous
• Ketamine (administration & dosage)
• Male
• Pain (drug therapy, etiology)
• Pain Management (methods)