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

Autor: Alshahrani MS; Emergency and Critical Care Departments, King Fahad Hospital of the University-Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia., AlSulaibikh AH; Emergency Department, King Fahad Hospital of the University-Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia., ElTahan MR; Anesthesiology Department, King Fahad Hospital of the University-Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia., AlFaraj SZ; Emergency Department, King Fahad Hospital of the University-Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia., Asonto LP; Emergency and Critical Care Departments, King Fahad Hospital of the University-Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia., AlMulhim AA; Emergency Department, King Fahad Hospital of the University-Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia., AlAbbad MF; Emergency Department, King Fahad Hospital of the University-Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia., Almaghraby N; Emergency Department, King Fahad Hospital of the University-Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia., AlJumaan MA; Emergency Department, King Fahad Hospital of the University-Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia., AlJunaid TO; Emergency Department, King Fahad Hospital of the University-Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia., Darweesh MN; Emergency Department, King Fahad Hospital of the University-Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia., AlHawaj FM; Emergency Department, King Fahad Hospital of the University-Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia., Mahmoud AM; Emergency Department, King Fahad Hospital of the University-Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia., Alossaimi BK; Emergency Department, King Fahad Hospital of the University-Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia., Alotaibi SK; Emergency Department, King Fahad Hospital of the University-Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia., AlMutairi TM; Emergency Department, King Fahad Hospital of the University-Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia., AlSulaiman PharmD DA; Pharmacy Department, King Fahad Hospital of the University-Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia., Alfaraj D; Emergency Department, King Fahad Hospital of the University-Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia., Alhawwas R; Emergency Department, King Fahad Hospital of the University-Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia., Mbuagbaw L; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada., Lewis K; Department of Medicine, McMaster University, Hamilton, Ontario, Canada., Verhovsek M; Department of Medicine, McMaster University, Hamilton, Ontario, Canada., Crowther M; Department of Medicine, McMaster University, Hamilton, Ontario, Canada., Guyatt G; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada., Alhazzani W; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
Jazyk: angličtina
Zdroj: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine [Acad Emerg Med] 2022 Feb; Vol. 29 (2), pp. 150-158. Date of Electronic Publication: 2021 Sep 21.
DOI: 10.1111/acem.14382
Abstrakt: 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.
(© 2021 The Authors. Academic Emergency Medicine published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine.)
Databáze: MEDLINE
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