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 (opens in new tab)
Study at a glance
AI-extracted from the abstract| 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 Esketamine |
| Keywords | Opioids Pain management Vaso‐occlusive crisis voc Ketamine therapy Sickle cell disease Opioid alternatives Anesthesia |
| Citations | 2 |
| Key findings | 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.
Comparable studies
Other systematic reviews and meta-analyses on ketamine, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| The effect of a single dose of intravenous ketamine on suicidal ideation: a systematic review and individual participant data meta-analysis Depressed patients with suicidal ideation at baseline | 2017 | Systematic review and individual participant data meta-analysis | n = 167 |
| Ketamine use: a review Ketamine users | 2011 | Systematic review | |
| Ketamine and Other NMDA Antagonists: Early Clinical Trials and Possible Mechanisms in Depression Participants with major depression in placebo-controlled, double-blind, randomized... | 2015 | Systematic review and meta-analysis | |
| Ketamine and postoperative pain – a quantitative systematic review of randomised trials Surgical patients from 25 countries | 2004 | Systematic review | n = 2,839 |
| Side-effects associated with ketamine use in depression: a systematic review. Patients with depression | 2018 | Systematic review |