Ketamine Administration for Acute Painful Sickle Cell Crisis: A Randomized Controlled Trial

Link to article at PubMed

Acad Emerg Med. 2021 Aug 27. doi: 10.1111/acem.14382. Online ahead of print.


OBJECTIVE: To evaluate the efficacy and safety of single-dose ketamine infusion in adults with sickle cell disease who presented with acute sickle vaso-occlusive crisis.

DESIGN: Parallel-group, prospective, randomized, double-blinded, pragmatic trial MAIN OUTCOME MEASURE: Participants were randomized to receive either a single dose of ketamine or morphine, infused over 30 min. Primary outcome was mean difference in the numerical pain rating score (NPRS) over two hours. NPRS was recorded every 30 min for a maximum of 180 min and secondary outcomes were cumulative dose of opioids, ED length of stay, hospital admission, change in vital signs, and drug-related side effects. Authors performed the analysis using intention-to-treat principle.

RESULT: 278 adults with sickle cell disease and presented with acute sickle vaso-occlusive crisis participated in this trial. 138 were allocated to the ketamine group. Mean numerical pain rating score over 2 h was 5•7 (2•13 SD) and 5•6 (1•90 SD) in the ketamine and morphine groups. Ketamine group received significantly lower cumulative doses of morphine during ED stay (mean 4•5 mg; 4•6 SD) than of the morphine group (mean 8•5 mg; 7•55 SD). Both groups had similar rates of hospital admission. 6•3% in Ketamine group has drug-related side effects, compared to 2•2% in the morphine group.

CONCLUSION: Early use of ketamine in adults with VOC resulted in a meaningful reduction in pain scores over a 2-h period and reduced the cumulative morphine dose in the ED with no significant drug-related side effects in the ketamine treated group.

PMID:34449939 | DOI:10.1111/acem.14382

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