Low-Dose Ketamine Infusion for Children With Sickle Cell Disease-Related Pain - Full Text View

Purpose

Acute pain episodes associated with sickle cell disease (SCD) are very difficult to manage effectively. Opioid tolerance and side effects have been major roadblocks in our ability to provide these patients with adequate pain relief. This pilot study is designed to examine the safety and feasibility of using ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, in the inpatient seeing with children and adolescents who have sickle cell vasoocclusive pain. Previous research suggests that in subanesthetic doses, ketamine may be able to prevent the development of opiate tolerance and facilitate better pain relief with lower opiate doses, allowing for less respiratory depression, less sedation, easier ambulation, less deconditioning, shorter hospital stays, and better quality of life. The goal of this pilot study is to evaluate the safety and feasibility of using a continuous infusion of ketamine, in conjunction with opiates, in the inpatient setting for sickle cell vasoocclusive pain. It is hypothesized that using a low dose ketamine infusion in conjunction with opiates will be a safe and feasible practice for the treatment of sickle cell pain.

Condition	Intervention	Phase
Sickle Cell Disease	Drug: ketamine	Phase 2


Study Type:	Interventional
Study Design:	Allocation: Non-Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Single Group Assignment Masking: Open Label Primary Purpose: Treatment
Official Title:	Use of Low-Dose Ketamine Infusion in Acute Painful Episodes of Sickle Cell Disease: A Pilot Study

Resource links provided by NLM:

Genetics Home Reference related topics: sickle cell disease

MedlinePlus related topics: Sickle Cell Anemia

Drug Information available for: Ketamine hydrochloride Ketamine

Genetic and Rare Diseases Information Center resources: Children's Interstitial Lung Disease Sickle Beta Thalassemia Sickle Cell Anemia

U.S. FDA Resources

Further study details as provided by Connecticut Children's Medical Center:

Primary Outcome Measures:

Side effects [ Time Frame: Continuous ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:

Intravenous opiate utilization [ Time Frame: Every 4 hours ] [ Designated as safety issue: No ]
Self-reported pain scores [ Time Frame: Every 4 hours ] [ Designated as safety issue: No ]


Enrollment:	3
Study Start Date:	January 2008
Study Completion Date:	June 2011
Primary Completion Date:	June 2011 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: 1 This group will receive ketamine	Drug: ketamine The medication will be administered intravenously. This study will utilize 4 doses of ketamine: 0.05 mg/kg/hour, 0.1 mg/kg/hour, 0.15 mg/kg/hour, and 0.2 mg/kg/hour. Dosing Regimen: All patients will begin the ketamine infusion at 0.05 mg/kg/hour. 4 or more hours after the infusion is started, the dose may be increased to 0.1 mg/kg/hour if: the patient's pain has not improved to an acceptable level (pain score is still ≥5) side effects remain acceptable 4 hours or more after the previous increase, the dose may be adjusted to 0.15 mg/kg/hour 4 hours or more after the previous increase, the dose may be adjusted to 0.2 mg/kg/hour The maximum dose of ketamine will be limited to 300 mg per 24 hours The patient may receive ketamine up to 72 hours after initiation. Other Name: Ketalar

Arms

Assigned Interventions

Experimental: 1

This group will receive ketamine

Drug: ketamine

The medication will be administered intravenously. This study will utilize 4 doses of ketamine: 0.05 mg/kg/hour, 0.1 mg/kg/hour, 0.15 mg/kg/hour, and 0.2 mg/kg/hour.

Dosing Regimen:

All patients will begin the ketamine infusion at 0.05 mg/kg/hour.
4 or more hours after the infusion is started, the dose may be increased to 0.1 mg/kg/hour if:
1. the patient's pain has not improved to an acceptable level (pain score is still ≥5)
2. side effects remain acceptable
4 hours or more after the previous increase, the dose may be adjusted to 0.15 mg/kg/hour
4 hours or more after the previous increase, the dose may be adjusted to 0.2 mg/kg/hour
The maximum dose of ketamine will be limited to 300 mg per 24 hours

The patient may receive ketamine up to 72 hours after initiation.

Other Name: Ketalar

Eligibility


Ages Eligible for Study:	7 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

CCMC: Children ages 7-22 years (inclusive) with documented sickle cell disease
UCHC: Adults 18 years (inclusive) and above with documented sickle cell disease
Sudden onset of acute pain consistent with a vasoocclusive episode -Pain requiring hospitalization, placement on pain protocol, and patient- controlled opiates
Pain score of greater than or equal to 5 out of 10 when ketamine infusion is started
Cognitive ability to report pain on a 0 to 10 Numerical Rating Scale (NRS)
At least one prior hospitalization for vasoocclusive pain at CCMC in the previous 24 months
Parental consent and child assent

Exclusion Criteria:

Children hospitalized for a primary diagnosis other than vasoocclusive episode
Concurrent Acute Chest Syndrome (ACS)
Hemoglobin < 5 mg/dL
Concurrent history of glaucoma or raised intracranial pressure
Signs or symptoms consistent with stroke
History of liver or renal dysfunction
Pregnancy (females age 12 and above must have pregnancy test)
Simultaneous participation in investigational drug study
Primary language spoken other than English
No hospitalizations to CCMC for vasoocclusive pain in the previous 24 months

Contacts and Locations

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00595530

Locations


United States, Connecticut
University of Connecticut Health Center
Farmington, Connecticut, United States, 06030
Connecticut Children's Medical Center
Hartford, Connecticut, United States, 06106

Sponsors and Collaborators

Connecticut Children's Medical Center

Investigators


Principal Investigator:	William T Zempsky, MD	Connecticut Children's Medical Center

More Information

No publications provided


Responsible Party:	William Zempsky, MD, Director, Pain Relief Program, Connecticut Children's Medical Center
ClinicalTrials.gov Identifier:	NCT00595530 History of Changes
Other Study ID Numbers:	07-101
Study First Received:	December 27, 2007
Last Updated:	July 29, 2013
Health Authority:	United States: Food and Drug Administration United States: Institutional Review Board

Keywords provided by Connecticut Children's Medical Center:


ketamine vasoocclusive pain

Additional relevant MeSH terms:


Anemia, Sickle Cell Anemia Anemia, Hemolytic Anemia, Hemolytic, Congenital Genetic Diseases, Inborn Hematologic Diseases Hemoglobinopathies Ketamine Analgesics Anesthetics Anesthetics, Dissociative Anesthetics, General	Anesthetics, Intravenous Central Nervous System Agents Central Nervous System Depressants Excitatory Amino Acid Agents Excitatory Amino Acid Antagonists Molecular Mechanisms of Pharmacological Action Neurotransmitter Agents Peripheral Nervous System Agents Pharmacologic Actions Physiological Effects of Drugs Sensory System Agents Therapeutic Uses

ClinicalTrials.gov processed this record on March 01, 2015