Safety and efficacy of ketamine use in patients with vaso-occlusive crisis: A systematic review and meta-analysis.
Ernesto Calderon Martinez, Stephin Zachariah Saji, Thomas Campos Carmona, Vaidarshi Abbagoni, Mohammad Salman, Mishell Estefanía Llerena Vargas, Suchita Mylavarapu, Druvini Fernando, Lakshmi Sheethal Arvapalli, Nathalia Schettino Samad, Nithin Karnan, Camila Sanchez Cruz
EJHaem December 1, 2024 DOI: 10.1002/jha2.1050 via PubMed
Summary
AI-generated from the abstractA systematic review and meta-analysis of five studies with 689 participants found that ketamine does not significantly reduce pain scores or opioid use compared to standard care during vaso-occlusive crises in sickle cell disease. Pain scores showed no significant difference, and morphine equivalent use also did not differ significantly. Ketamine was associated with a fivefold higher risk of mild side effects such as nausea, vomiting, and dizziness, though no severe adverse events were reported. The authors suggest ketamine may have potential for improving pain management, but current evidence does not demonstrate statistically significant benefits, and further research with larger samples is needed to clarify optimal dosing and protocols.
Study at a glance
| Characteristics | Systematic review and meta-analysis Randomized Qualitative Peer reviewed |
|---|---|
| Sample size | 689 |
| Population | Sickle cell disease patients experiencing vaso-occlusive crises |
| Intervention | Ketamine |
| Topics | Ketamine |
| Keywords | Opioids Pain management Vaso‐occlusive crisis voc Ketamine therapy Sickle cell disease |
| Citations | 2 |
| Key finding | Ketamine did not significantly reduce pain scores or opioid use compared to standard care, but was associated with a significantly higher risk of mild side effects. |
Abstract
Sickle cell disease (SCD) is characterized by acute episodes called vaso-occlusive crises (VOC). VOC is marked by severe pain due to blocked blood vessels by sickled cells. Ketamine has been reported to be effective and safe in managing VOC in SCD patients. This review aims to determine ketamine's safety and efficacy through analysis of clinical trials and observational studies. Adhering to PRISMA guidelines, this systematic review and meta-analysis systematically searched seven databases on May 20, 2024 for randomized control trials (RCT), cohorts, and case-control studies. Five studies with 689 participants met the inclusion criteria. A meta-analysis of two studies (518 observations) for the Numerical Rating Scale (NRS) pain score showed no significant difference, with a standardized mean difference (MD) of 0.23 (95% CI: -0.13 to 0.59, p = 0.21, I 2 = 0%). For morphine milligram equivalent (MME), a meta-analysis of two studies (344 observations) resulted in an MD of -0.03 (95% CI: -0.09 to 0.04, p = 0.45, I 2 = 97%). However, the side effects analysis from four studies (608 observations) showed a significantly higher relative risk (RR) of 5.74 (95% CI: 2.80-11.79, p < 0.0001, I 2 = 0%) for mild side effects, including nausea, vomiting, and dizziness. Ketamine qualitative synthesis shows potential for improving pain management in SCD patients during VOC, but without statistically significant differences in pain reduction. It is associated with increased mild side effects, though no severe adverse events were reported. Further research is needed to increase the sample size and power of the analysis to clarify optimal dosing and administration protocols for ketamine in this context.