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

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00595530
Recruitment Status : Terminated (Lack of enrollment and patient interest in study)
First Posted : January 16, 2008
Results First Posted : March 30, 2016
Last Update Posted : August 21, 2019
Information provided by (Responsible Party):
William Zempsky, MD, Connecticut Children's Medical Center

Brief Summary:
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 or disease Intervention/treatment Phase
Sickle Cell Disease Drug: ketamine Phase 2

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 3 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Use of Low-Dose Ketamine Infusion in Acute Painful Episodes of Sickle Cell Disease: A Pilot Study
Actual Study Start Date : March 4, 2008
Actual Primary Completion Date : February 12, 2010
Actual Study Completion Date : February 12, 2010

Resource links provided by the National Library of Medicine

Drug Information available for: Ketamine

Arm Intervention/treatment
Experimental: Ketamine
This group will receive ketamine
Drug: ketamine

Medication administered via IV. This study will utilize 4 doses of ketamine: 0.05 mg/kg/hr, 0.1 mg/kg/hr, 0.15 mg/kg/hr, and 0.2 mg/kg/hr.

Dosing Regimen:

  • Patients begin the ketamine infusion at 0.05 mg/kg/hr.
  • 4 or more hrs after infusion is started, the dose may be increased to 0.1 mg/kg/hr if:

    1. patient's pain has not improved to an acceptable level
    2. side effects remain acceptable
  • 4 hrs or more after the previous increase, the dose may be adjusted to 0.15 mg/kg/hr
  • 4 hrs or more after the previous increase, the dose may be adjusted to 0.2 mg/kg/hour
  • Maximum dose of ketamine is limited to 300 mg per 24 hrs

Patient may receive ketamine up to 72 hrs after initiation.

Other Name: Ketalar

Primary Outcome Measures :
  1. Number of Participants With Improvement in Pain Scores of >2 Points on the Pain Scale [ Time Frame: Baseline then daily while inpatient, up to 72 hours ]
    Determine if there is an apparent improvement in pain control with the ketamine infusion based on the investigator's discretion and comparison to past pain scores. Pain was scored on a scale from 0 to 10. Zero equaled no pain and 10 equaled a lot of pain.

Secondary Outcome Measures :
  1. Number of Participants Who Showed a Reduction of Opioid Utilization While on IV Ketamine [ Time Frame: Baseline then daily while inpatient, up to 72 hours ]
    Looking at the reduction of opioid utilization while on IV Ketamine. Three participants were enrolled in the study, therefore a comprehensive analysis could not be done due to the low enrollment.

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Ages Eligible for Study:   7 Years and older   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

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

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00595530

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

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Responsible Party: William Zempsky, MD, Director, Pain Relief Program, Connecticut Children's Medical Center Identifier: NCT00595530     History of Changes
Other Study ID Numbers: 07-101
First Posted: January 16, 2008    Key Record Dates
Results First Posted: March 30, 2016
Last Update Posted: August 21, 2019
Last Verified: August 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Plan Description: There is no plan to share data as the low enrollment makes the results of this study non-generalizable.
Keywords provided by William Zempsky, MD, Connecticut Children's Medical Center:
vasoocclusive pain
Additional relevant MeSH terms:
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Anemia, Sickle Cell
Anemia, Hemolytic, Congenital
Anemia, Hemolytic
Hematologic Diseases
Genetic Diseases, Inborn
Sensory System Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Anesthetics, Dissociative
Anesthetics, Intravenous
Anesthetics, General
Central Nervous System Depressants
Excitatory Amino Acid Antagonists
Excitatory Amino Acid Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action