Journal article
Ketamine for Sickle Cell Vaso-Occlusive Crises: A Systematic Review

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Publication Details
Author list: Alshahrani M
Publisher: Medknow Publications
Publication year: 2020
Journal: Saudi Journal of Medicine and Medical Sciences
Journal acronym: SJMMS
Volume number: 9
Issue number: 1
Start page: 3
End page: 9
Number of pages: 7
ISSN: 1658-631X
Web of Science ID:
PubMed ID:
Scopus ID:
eISSN: 2321-4856

Introduction: Vaso-occlusive crisis (VOC) is one of the main
causes of hospital admission in patients with sickle cell disease (SCD).
Ketamine is often used as an adjuvant to opioids to control sickle cell crisis;
however, there is a lack of evidence about its safety and efficacy for VOC in
SCD patients.

Objective: To synthesize evidence from published reports
about the efficacy and safety of ketamine in the management of acute painful
VOC in both pediatric and adult SCD patients.

Methods: A systematic literature search of PubMed, Scopus,
Web of Science, EBSCO and Cochrane Library was conducted, up to March 2019.
Studies reporting the analgesic effects and side effects of ketamine in the
management of acute painful VOC in pediatric and adult SCD patients were
included. The primary outcome measure was improvement in pain scale, and the
secondary outcomes were reduction in opioid utilization and side effects.
Studies were narratively summarized in this review.

Results: Fourteen studies (with a total of 604 patients)
were included in the final analysis. Several case reports and case series
showed that ketamine significantly reduced pain scales and opioid utilization
in both populations. The only randomized controlled trial available showed that
ketamine was noninferior to morphine in reducing pain scores, but had a higher
incidence of nonlife-threatening, reversible adverse effects. However, a
retrospective study of 33 patients showed a higher pain score in the ketamine
group with an acceptable short-term adverse effect.

Conclusion: Ketamine has a potentially comparable efficacy
with other opioids in reducing the pain during VOC in SCD patients. However, it
also likely has a higher rate of transient adverse events. Owing to the lack of
published randomized controlled trials, current evidence is not sufficient to
confirm the safety and efficacy of ketamine. Future well-designed randomized
controlled trials are strongly recommended.

Keywords: Ketamine; pain; sickle cell disease; systematic
review; vaso-occlusive crisis.

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Last updated on 2021-19-10 at 09:34