Management of refractory pain in pediatric sickle cell disease (SCD) and oncology is reliant on opioids though high opioid dosing increases side effects and tachyphylaxis. We introduced low-dose ketamine infusion (LDKI) to our inpatient unit to determine if LDKI was tolerable. We subsequently hypothesized that LDKI would improve pain scores. We reviewed inpatients from LDKI initiation in March 2014 through October 2017, with the day before LDKI initiation compared with the day of LDKI initiation and 2 subsequent days. For patients with SCD, the LDKI admission was compared with up to 3 admissions in the prior year for a vaso-occlusive event. Nineteen patients (12 oncology, 7 SCD) with a median age of 14.6 years received LDKI for a median of 6 days at a median initial dose of 0.06 mg/kg/h (1.1 µg/kg/min). There was no change in pain scores or opioid utilization when comparing the day before LDKI initiation with subsequent days. No patient discontinued LDKI because of intolerability. For patients with SCD, there was a median 32% reduction in cumulative pain scores when comparing the LDKI admission with prior admissions. LDKI is well tolerated for refractory pediatric cancer-related and sickle cell-related pain.

中文翻译：

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儿童血液学/肿瘤学患者的低剂量氯胺酮输注：病例系列和文献综述。

小儿镰状细胞病 (SCD) 和肿瘤的顽固性疼痛的治疗依赖于阿片类药物，尽管高阿片类药物剂量会增加副作用和快速耐受。我们在住院部引入了低剂量氯胺酮输注 (LDKI)，以确定 LDKI 是否可以耐受。我们随后假设 LDKI 会改善疼痛评分。我们回顾了 2014 年 3 月至 2017 年 10 月期间开始 LDKI 的住院患者，其中开始 LDKI 的前一天与开始 LDKI 的当天以及随后的 2 天进行了比较。对于 SCD 患者，将 LDKI 入院与前一年因血管闭塞事件而入院的多达 3 例患者进行比较。19 名患者（12 名肿瘤患者，7 名 SCD），中位年龄为 14.6 岁，接受 LDKI 治疗中位时间为 6 天，中位初始剂量为 0.06 mg/kg/h（1.1 µg/kg/min）。LDKI 开始前一天与随后几天进行比较时，疼痛评分或阿片类药物使用没有变化。没有患者因无法耐受而停用 LDKI。对于 SCD 患者，将 LDKI 入院与之前入院进行比较时，累积疼痛评分中位数降低了 32%。LDKI 对于顽固性儿科癌症相关和镰状细胞相关疼痛具有良好的耐受性。