399 - Ultra-low dose ketamine is safe and effective at reducing pain scores in pediatric patients
Sunday, April 30, 2023
3:30 PM – 6:00 PM ET
Poster Number: 399 Publication Number: 399.314
Jennifer A. Busse, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States; William S. Schechter, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Jennifer Busse, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States; Mary E. Tresgallo, Columbia University School of Nursing, white plains, NY, United States; Justin Genziano, University of California, San Francisco, School of Medicine, San Francisco, CA, United States
Nurse Practitioner NewYork-Presbyterian Morgan Stanley Children's Hospital New York, New York, United States
Background: Ketamine is increasingly used in pediatrics as an adjuvant for pain control to treat nociceptive and neuropathic pain, decrease opioid requirements, opioid related adverse effects and mitigate development of opioid tolerance. The reported effective dose range of ketamine is 0.05-1 milligrams (mg)/kilogram (kg)/hour (h) in children1,2. Our institution utilizes ketamine at doses far below these recommendations with good effect. Objective: We examined our use of ultra-low dose (ULD) ketamine over the course of 6 months and report its safety and effectiveness when used as an adjuvant to opioids. Design/Methods: Parental consent was waived by IRB. This was a prospective study of 10 pain patients from August to December 2022. We examined patient characteristics, ketamine dose, adverse effect profile, as well as 24 hour pre- and post-ULD ketamine average total opioid dose, pain score, and sedation score. Results: 10 patients received ULD ketamine concurrently with opioids during our study period. The age range was 2 to 22 years of age with the median being 16 years. The ULD ketamine dose range for pediatric pain patients was between 0.024 to 0.048mg/kg/h. The total opioid dose after 24 hours of ketamine administration was approximately the same as 24 hours prior to ketamine. Pain scores were significantly decreased 24 hours after ketamine initiation. Sedation scores were unchanged. Ketamine-related side effects were uncommon with only mild hallucinations reported in one case, which did not require treatment or cessation of ketamine. There were no major adverse events (see Table 1).
Conclusion(s): The low doses of ketamine we describe, when used as an opioid adjuvant, appear to be safe and effective at reducing pain scores by almost 50%.Adverse effects related to ketamine at these doses were rare and very mild. ULD ketamine appears to be a safe and effective adjuvant. A larger study may show a reduction in total opioid requirement and/or a decrease in opioid-induced adverse effects. A prospective randomized study is warranted to further evaluate the use of ULD ketamine in pediatric patients.
References 1. Masaracchia MM, Sites BD, Lee J, Thomas J, Fernandez PG. Subanesthetic ketamine infusions for the management of pediatric pain in non-critical care settings: An observational analysis. Acta Anaesthesiol Scand. 2019;63:1225-1230. 2. Bredlau AL, Thakur R, Korones DN, Dworkin RH. Ketamine for pain in adults and children with cancer: A systematic review and synthesis of the literature. Pain Medicine. 2013;14:1505-15-17.
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