One of the major and most encumbering complications of sickle cell disease (SCD) are recurrent episodes of acute pain crises, which are often superimposed on chronic pain and managed with high opiate dosages. Consequently, recurrent acute painful episodes may lead to opioid tolerance, transition to chronic pain, and in some cases, opioid-induced hyperalgesia (OIH). A review of the literature reveals anecdotal case reports of ketamine infusion for patients whose SCD pain crises were refractory to opioids, resulting in reduced pain scores and opioid use, and suggesting that ketamine may serve as a useful adjunct in the management of severe SCD-induced pain. We present our experience with 10 opioid-tolerant adult patients with SCD who were admitted to the University of Colorado Hospital for acute exacerbation of pain refractory to opioid therapy. These patients received a total of 72 continuous ketamine infusions, representing the largest reported experience to date. Sixty-six (91.7%) of the administrations led to reduced pain intensity scores (from an average of 7.88 to 4.25 out of 10) and reduced opioid intake. Only a total of 8 administrations (11.1%) caused side effects, including hallucinations and vomiting, that led to discontinuation. Ongoing analysis will determine if there is a subsequent sustained reduction in chronic opioid dosing. These data suggest ketamine infusion may be beneficial as an analgesic adjunct in the management of severe acute pain in patients with SCD. However, a randomized trial will be necessary to cultivate an evidence-based protocol for the use of ketamine infusion as a therapeutic option for patients with SCD whose pain become severe and refractory to opioids.
© 2017 Published by Elsevier Inc.