Ketamine administration for acute painful sickle cell crisis: A randomized controlled trial

Objective The objective was to evaluate the efficacy and safety of single‐dose ketamine infusion in adults with sickle cell disease (SCD) who presented with acute sickle vasoocclusive crisis (VOC). Methods This study was a parallel‐group, prospective, randomized, double‐blind, pragmatic trial. Parti...

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Published in:Academic emergency medicine 2022-02, Vol.29 (2), p.150-158
Main Authors: Alshahrani, Mohammed S., AlSulaibikh, Amal H., ElTahan, Mohamed R., AlFaraj, Sukayna Z., Asonto, Laila P., AlMulhim, Abdullah A., AlAbbad, Murad F., Almaghraby, Nisreen, AlJumaan, Mohammed A., AlJunaid, Thamir O., Darweesh, Moath N., AlHawaj, Faisal M., Mahmoud, Alaa M., Alossaimi, Bader K., Alotaibi, Shaikhah K., AlMutairi, Talal M., AlSulaiman PharmD, Duaa A., Alfaraj, Dunya, Alhawwas, Reem, Mbuagbaw, Lawrence, Lewis, Kim, Verhovsek, Madeleine, Crowther, Mark, Guyatt, Gordon, Alhazzani, Waleed
Format: Article
Language:English
Subjects:
Acute Pain - drug therapy
Acute Pain - etiology
Analgesics - therapeutic use
Analgesics, Opioid - therapeutic use
Anemia, Sickle Cell - complications
Anemia, Sickle Cell - drug therapy
Clinical trials
Double-Blind Method
Drug dosages
Emergency medical care
Humans
Ketamine
Morphine
Original Contribution
Original Contributions
Pain management
Pain Measurement - methods
Prospective Studies
Sickle cell disease
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Summary:Objective The objective was to evaluate the efficacy and safety of single‐dose ketamine infusion in adults with sickle cell disease (SCD) who presented with acute sickle vasoocclusive crisis (VOC). Methods This study was a parallel‐group, prospective, randomized, double‐blind, pragmatic trial. Participants were randomized to receive a single dose of either ketamine or morphine, infused over 30 min. Primary outcome was mean difference in the numerical pain rating scale (NPRS) score over 2 h. NPRS was recorded every 30 min for a maximum of 180 min and secondary outcomes were cumulative dose of opioids, emergency department (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 A total of 278 adults with SCD and who presented with acute sickle VOC participated in this trial. A total of 138 were allocated to the ketamine group. Mean (±standard deviation [SD]) NPRS scores over 2 h were 5.7 (±2.13) and 5.6 (±1.90) in the ketamine and morphine groups. The ketamine group received significantly lower cumulative doses of morphine during their ED stay (mean ± SD = 4.5 ± 4.6 mg) than of the morphine group (mean ± SD = 8.5 ± 7.55 mg). Both groups had similar rates of hospital admission: 6.3% in the ketamine group had 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.
ISSN:1069-6563
1553-2712
DOI:10.1111/acem.14382