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Ketamine PCA for treatment of end-of-life neuropathic pain in pediatrics
Matthew Taylor1, Regina Jakacki2, Carol May3
1Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Insights
Ketamine patient-controlled analgesia (PCA) effectively manages neuropathic pain (NP) in children nearing end of life. This well-tolerated therapy provided pain relief and reduced opioid needs for pediatric patients.
Area of Science:
- Palliative Care
- Pediatric Oncology
- Pain Management
Background:
- Neuropathic pain (NP) control in children at end of life presents significant challenges.
- Ketamine is known to improve NP control, but its pediatric application is not well-documented.
Purpose of the Study:
- To evaluate the efficacy and safety of ketamine patient-controlled analgesia (PCA) for managing opioid-refractory NP in pediatric patients with terminal prognoses.
Main Methods:
- A retrospective case review of 14 children with terminal prognoses receiving ketamine PCA for opioid-refractory NP.
- Analysis of ketamine dosage, patient-reported pain relief, adverse effects, and impact on opioid requirements.
Main Results:
- All patients experienced subjective pain relief with ketamine PCA.
- 79% of patients reported no adverse effects; benzodiazepines mitigated neuropsychiatric side effects.
- Ketamine PCA halted opioid dose escalation in 64% of patients, with 79% discharged to home hospice.
Conclusions:
- Ketamine PCA is an effective and well-tolerated treatment for opioid-refractory neuropathic pain in pediatric end-of-life care.
- This approach can improve pain management and facilitate discharge to home hospice settings.
Abstract:
Control of neuropathic pain (NP) for children at end of life is challenging. Ketamine improves control of NP, but its use in children is not well described. We describe a retrospective case review of 14 children with terminal prognoses treated with ketamine patient-controlled analgesia (PCA) for management of opioid-refractory NP at the end of life. Median ketamine dose was 0.06 mg/kg/h (range 0.014-0.308 mg/kg/h) with a 0.05 mg/kg (range 0.03-0.5mg/kg) demand dose available every 15 minutes (range 10-60 minutes). All patients noted subjective pain relief with ketamine, and 79% had no adverse effects. Benzodiazepines limited neuropsychiatric side effects. Ketamine treatment arrested dose escalation of opioids in 64% of patients, and 79% were discharged to home hospice. Ketamine PCA is an effective, well-tolerated therapy for opioid-refractory NP in pediatric end-of-life care.
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