Intravenous ketamine infusion as an adjuvant to morphine in a 2-year-old with severe cancer pain from metastatic neuroblastoma
Female; Humans; Palliative Care; Pain; Analgesics; Fatal Outcome; quality of life; Preschool; Non-U.S. Gov't; Research Support; Administration; Oral; Infusions; Intravenous; Intractable/drug therapy/etiology; Combination; Codeine/administration & Drug Therapy; Dyspnea/chemically induced; Hallucinations/chemically induced; Ketamine/administration & Methadone/administration & dosage/adverse effects/therapeutic use; Morphine/administration & Neuroblastoma/physiopathology; Non-Narcotic/administration & dosage/therapeutic use; Opioid/administration & Child
A 2.8-year-old female patient (11.6 kg) was admitted to the hospital for uncontrolled pain and swelling in the left leg relating to a metastatic neuroblastoma. Initially, her pain was managed with oral morphine 2 mg (approx. 0.2 mg/kg) every 4 hours. Because she was quite somnolent but still in significant pain, analgesia was then changed to methadone 1 mg orally every 6 hours (approximately 0.1 mg/kg/dose) and was eventually increased over 36 hours to 2 mg every 6 hours (approximately 0.2 mg/kg/dose). She received oral methadone 0.6 mg (approximately 0.05 mg/kg) every 4 hours as needed for breakthrough pain. She continued to have severe pain and experienced side effects, including respiratory depression, sedation, visual hallucinations, and vomiting. An intravenous ketamine infusion was started at 100 microg/kg/hour. Regular opioid administration was ceased, but she was given intravenous morphine 0.5 to 0.75 mg for breakthrough pain. She required only zero to three doses of breakthrough morphine per day, initially. After starting the ketamine infusion, her pain control improved and her symptoms of opioid toxicity abated. She was more alert and able to partake in limited activities. As a result of pain from progressive disease, the ketamine infusion was increased to 200 microg/kg/hour after 6 days with positive results. Her condition continued to deteriorate. An intravenous morphine infusion was initiated 2 weeks after starting the ketamine infusion and was eventually increased to 50 microg/kg/hour. One week later, she died with reasonable pain control. This case illustrates the use of ketamine as an effective analgesic in an adjuvant setting in a pediatric patient with advanced poorly controlled cancer pain. Ketamine not only eased the child's suffering while preserving life but also improved her quality of life by maintaining the child's ability to communicate and engage in activities.
2004
Tsui BC; Davies D; Desai S; Malherbe S
Journal Of Pediatric Hematology/oncology
2004
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1097/01.mph.0000140656.96085.2c" target="_blank" rel="noreferrer">10.1097/01.mph.0000140656.96085.2c</a>
Pediatric acute pain management
Child; infant; Analgesics; Time Factors; Acute Disease; Nebulizers and Vaporizers; Anesthetics; Preschool; infant; Chronic disease; Newborn; Infusions; Intravenous; Human; Local/therapeutic use; Nerve Block/methods; Non-Narcotic/administration & dosage/therapeutic use; Opioid/administration & dosage/blood/therapeutic use; Pain/drug therapy/physiopathology
The past decade has brought about an explosion of knowledge about the physiology of nociception and many new techniques for pain relief, new analgesic drugs, and new applications of old analgesic drugs. These techniques include methods of opioid administration by transdermal and transmucosal absorption and the use of neuraxial analgesia for the management of pain in children. Interest in the use of regional anesthesia in children has been rekindled, and analgesic properties and pre-emptive analgesic properties of many agents not typically considered analgesics, such as clonidine and ketamine, have been recognized. Perhaps the greatest advance has been the paradigm shift in the recognition that pain not only exists in infants and children but also is a significant cause of morbidity and even mortality. Given the unprecedented interest in pain management in adults and children, physicians can now look forward to the development of new methods of drug delivery and of receptor-specific drugs that divorce analgesia from the untoward side effects of existing analgesics. Improvement in the quality of life of hospitalized children also will occur.
2000
Golianu B; Krane EJ; Galloway KS; Yaster M
Pediatric Clinics Of North America
2000
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/s0031-3955(05)70226-1" target="_blank" rel="noreferrer">10.1016/s0031-3955(05)70226-1</a>
Assessment of nurses' judgement for analgesic requirements of postoperative children
Child; Female; Humans; Male; Pain; Analgesics; Nursing Assessment; Preschool; Non-Narcotic/administration & dosage/therapeutic use; Acetaminophen/administration & dosage/therapeutic use; Postoperative/drug therapy/psychology; Suppositories; Tonsillectomy
Over the last 5-10 years, there has been significant growth in the knowledge and strategies of pain management in children. Investigations are required to discern whether concomitant improvements in clinical practice have occurred. The purpose of this study was to identify the nurses' administration of a traditional analgesic (acetaminophen) with regard to appropriate doses and time intervals. This issue was examined, within 24 h after surgery, in 72 children (aged 3-12 years) scheduled for a tonsillectomy. Acetaminophen suppositories were administered in subtherapeutic doses and at too large time intervals. An average single dose administered represented 87% of the calculated dose. Comparison between the correct dose, which should have been given considering the dose levels of the suppositories available, and the actual dose administered indicates that the nurses tended to round doses down to the next lowest. The average dosage administered per day represented only 76% of the recommended dosage. The prevalence of pain amongst the children was high both before and after analgesics, indicating that acetaminophen in the doses used did not provide any significant measure of pain relief. Current practice is still not optimal. Educating nurses on the effective use of traditional pain therapies may improve paediatric pain management.
1996
Romsing J
Journal Of Clinical Pharmacy And Therapeutics
1996
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1111/j.1365-2710.1996.tb00016.x" target="_blank" rel="noreferrer">10.1111/j.1365-2710.1996.tb00016.x</a>