Reply To: Ketamine for sickle cell pain

  • Dyane Bunnell

    Member
    July 23, 2021 at 10:05 am

    We’ve been using ketamine for sickle cell pain with some pretty good opioid-sparing results. Recently we implemented a protocol of “low-dose” ketamine that allows us to administer the infusion on the acute care unit, as opposed to the ICU. For now, we are limiting these infusions to the palliative care team or the pain team. 
    We are already considering raising the max dose limit because we are finding that some of our adolescents aren’t getting the relief we’d hoped for.

     

    Low-dose Ketamine for Adjuvant Pain Management and Postoperative Analgesia

    Dosing

    0.05 mg/kg/hr – 0.3 mg/kg/hr

    (MAX DOSE 10 mg/hr)

    Age

    Not recommended for patients less than 2 years of age or less than 5 kg

    Prescribing ketamine

    Only the Pain Management or Palliative Care Service can initiate or adjust rate of low-dose ketamine infusions.

     

    Prescribing other opioids and benzodiazepines

    Only the Pain Management or Palliative Care Service can prescribe opioids and benzodiazepines for patients with low-dose ketamine infusions.

     

    Monitoring

     

     

    Continuous cardiorespiratory and pulse oximetry monitoring.

    Infusion Device

     

     

    Carefusion AlarisTM PCA pump module

    Alaris Drug Library

    Use Ketamine infusion in Alaris Drug Library

    Vital signs

     

    First 24 hours start/rate increase

    HR/RR every 30 min x2, then every 2 hours

    After 24 hours

    Every 4 hours

    BP every 4 hours

    Pain Score

     

    Every 4 hours

    Sedation score

     

    First 24 hours every 2 hours

    After 24 hours every 4 hours

     

    ——————————
    Dyane Bunnell, APRN,CPON,MSN,RN
    Clinical Nurse Specialist
    Wilmington, DE
    United States
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    ——————————————-
    Original Message:
    Sent: 07-01-2021 08:35 AM
    From: Elizabeth Sonnenblick
    Subject: Ketamine for sickle cell pain

    Does anybody use ketamine for Sickle cell pain?  Do you have a protocol that you would be willing to share

    Thanks

    ——————————
    Elizabeth Sonnenblick, CPHON,CPNP,MSN,RN
    St Joseph’s Regional Medical Center
    Paterson, NJ
    United States
    ——————————