The effect of ketamine infusion on pain control in the painful crisis of the patients with sickle cell anemia in childhood

ABSTRACT The Effect of Ketamine Infusion on Pain Control in the Painful Crisis of the Patients with Sickle Cell Anemia in Childhood Purpose: Sickle cell anemia (OHA) is a hemoglobinopathy which is hemoglobin solubility is impaired as a result of the replacement of glutamic acid with valine in the 6th position of the β globin chain. In patients with autosomal recessive inheritance, Hb is used in patients with homozygous status, sickle cell anemia (SCA) is used. The most important factor in the pathogenesis of the disease is vascular-occlusion. Vaso-occlusive crises of pediatric patients with sickle cell anemia often lead to pain that requiring inpatient treatment.5 Painful crises are effectively managed by painkiller drugs, hydration and frequent examination in the emergency department of the hospital. Ketamine infusions have been shown to be beneficial in patients who without pain control after conventional pain control methods. In our study, we used the VAS scoring system in sickle cell patients who applied to the emergency department due to acute pain and determined the severity of the pain and the effect of side effects on ketamine and tramadol. it is aimed to retrospectively analizing and developing these treatment methods. Materials and Methods: In this study, retrospectively, observational, single-centered patients who were admitted to the pediatric emergency department with pediatric sickle cell anemia with painful crisis were examined between 01.01.2017 and 30.08.2018 at Cukurova University of Medical Faculty Balcalı Hospital. Age, gender, duration of pain, drug dose, additional dose requirement, additional medication, vital signs, other medication used, vomiting-nausea, laryngeal spasm, desaturation another complication development, pain scores were recorded from the Visuel Pain Scale (VAS) in archive files. When the patients who were receiving ketamine and tramadol infusion their pain score were recorded at filed 0,5, 10, 30, 60 minutes and in the Pediatric Emergency Departmant, in addition their pain score rutinly recorded before and after drug administration. Results: A total of 78 sickle cell patients were included in the study, 38 (50%) were male and 38 (50%) were female. The mean age and standard deviation of the patients included in the study were 14.93±3.69. When the pain grade of the patients was classified according to VAS, mild (3.9%), moderate 27 (35.5%) and severe 46 (60.5%). 32 patients (42.1%) had tramadol and 16 patients (21.1%) underwent ketamine infusion for the treatment of patients with moderate to severe pain. 0, 5, 10, 20, 60. VAS change was recorded in minutes. The mean VAS score was 7.69±1.76 in the tramadol group and 9±1.26 in the ketamine group. 32 patients (42.1%) had tramadol and 16 patients (21.1%) had ketamine infusion. Average VAS score at 60 minutes; while tramadol infusion was 4.96±0.48 in the group treated with ketamine infusion, it was 3.31±0.68. There was a statistically significant difference between the two groups in terms of VAS values at 60th minute (p = 0.039). Conclusion: In our study, severe and moderately painful complete relief (>5 points decrease in VAS) was performed at 20 minutes in ketamine infusion group. Tramadol infusion was performed in 60 minutes. As a result, ketamine treatment was found to be more effective than tramadol in the first hour in the treatment of painful crises. Ketamine should be considered as an option in the rapid treatment of painful crises because the effect of tramadol treatment is longer in the first hour. Expected Benefits: Fast-effective pain control with ketamine infusion is expected in painful crises in SCA. Keywords: Sickle Cell Disease, Painful Crises, Ketamine