RT Journal Article
SR Electronic
T1 Low-dose ketamine adjuvant treatment for refractory pain in children, adolescents and young adults with cancer: a pilot study
JF BMJ Supportive & Palliative Care
JO BMJ Support Palliat Care
FD British Medical Journal Publishing Group
SP bmjspcare-2018-001739
DO 10.1136/bmjspcare-2018-001739
A1 Magali Courade
A1 Amandine Bertrand
A1 Lea Guerrini-Rousseau
A1 Anne Pagnier
A1 Dominique Levy
A1 Cyril Lervat
A1 Nadine Cojean
A1 Alice Ribrault
A1 Sophie Dugue
A1 Sandrine Thouvenin
A1 Christophe Piguet
A1 Claudine Schmitt
A1 Perrine Marec-Berard
YR 2019
UL http://spcare.bmj.com/content/early/2019/05/31/bmjspcare-2018-001739.abstract
AB Objectives Ketamine, an N-methyl-D-aspartate receptor antagonist, is effective at relieving adult cancer pain, although there have been very few reports to date regarding its use in children and in adolescents and young adults (AYA). This study assessed the efficacy, safety and opioid-sparing effects of low doses of ketamine added to opioid analgesics to alleviate persistent cancer pain.Methods This prospective, multicentre, observational trial collected data regarding demographics, pain characteristics, pain score assessment within the first 48 hours of ketamine administration, tolerance and satisfaction from 38 patients aged 2–24 years prescribed with ketamine as an adjuvant antalgic for refractory cancer pain in 10 French paediatric oncology centres.Results The mean visual analogue scale pain score decreased from 6.7 to 4.3 out of 10 (n=39, p<0.001) from day 1 to day 3 and by at least 2 points in 56% of the patients (n=22) 48 hours after initiation of ketamine. Nine patients experienced poor tolerance (≥2 side effects), all with infusion rates lower than 0.05 mg/kg/hour. None had limiting toxicities. An opioid-sparing effect was highlighted in four patients. Fifty-four per cent of the prescribers and 47% of the patients found the addition of ketamine ‘very helpful’.Conclusions Low doses of ketamine as an adjuvant to opioids significantly reduced the intensity of pain in half of the study population. A tendency towards better pain control is shown, although a lack of statistical power somewhat limits our conclusions, especially in children. Nevertheless, ketamine may be a useful option for improving the treatment of refractory pain in children and AYA with cancer.