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Low-Dose Ketamine Infusion for Children With Sickle Cell Disease-Related Pain

Primary Purpose

Sickle Cell Disease

Status
Terminated
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
ketamine
Sponsored by
Connecticut Children's Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Sickle Cell Disease focused on measuring ketamine, vasoocclusive pain

Eligibility Criteria

7 Years - undefined (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • CCMC: Children ages 7-22 years (inclusive) with documented sickle cell disease
  • UCHC: Adults 18 years (inclusive) and above with documented sickle cell disease
  • Sudden onset of acute pain consistent with a vasoocclusive episode -Pain requiring hospitalization, placement on pain protocol, and patient- controlled opiates
  • Pain score of greater than or equal to 5 out of 10 when ketamine infusion is started
  • Cognitive ability to report pain on a 0 to 10 Numerical Rating Scale (NRS)
  • At least one prior hospitalization for vasoocclusive pain at CCMC in the previous 24 months
  • Parental consent and child assent

Exclusion Criteria:

  • Children hospitalized for a primary diagnosis other than vasoocclusive episode
  • Concurrent Acute Chest Syndrome (ACS)
  • Hemoglobin < 5 mg/dL
  • Concurrent history of glaucoma or raised intracranial pressure
  • Signs or symptoms consistent with stroke
  • History of liver or renal dysfunction
  • Pregnancy (females age 12 and above must have pregnancy test)
  • Simultaneous participation in investigational drug study
  • Primary language spoken other than English
  • No hospitalizations to CCMC for vasoocclusive pain in the previous 24 months

Sites / Locations

  • University of Connecticut Health Center
  • Connecticut Children's Medical Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Ketamine

Arm Description

This group will receive ketamine

Outcomes

Primary Outcome Measures

Number of Participants With Improvement in Pain Scores of >2 Points on the Pain Scale
Determine if there is an apparent improvement in pain control with the ketamine infusion based on the investigator's discretion and comparison to past pain scores. Pain was scored on a scale from 0 to 10. Zero equaled no pain and 10 equaled a lot of pain.

Secondary Outcome Measures

Number of Participants Who Showed a Reduction of Opioid Utilization While on IV Ketamine
Looking at the reduction of opioid utilization while on IV Ketamine. Three participants were enrolled in the study, therefore a comprehensive analysis could not be done due to the low enrollment.

Full Information

First Posted
December 27, 2007
Last Updated
August 6, 2019
Sponsor
Connecticut Children's Medical Center
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1. Study Identification

Unique Protocol Identification Number
NCT00595530
Brief Title
Low-Dose Ketamine Infusion for Children With Sickle Cell Disease-Related Pain
Official Title
Use of Low-Dose Ketamine Infusion in Acute Painful Episodes of Sickle Cell Disease: A Pilot Study
Study Type
Interventional

2. Study Status

Record Verification Date
August 2019
Overall Recruitment Status
Terminated
Why Stopped
Lack of enrollment and patient interest in study
Study Start Date
March 4, 2008 (Actual)
Primary Completion Date
February 12, 2010 (Actual)
Study Completion Date
February 12, 2010 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Connecticut Children's Medical Center

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Acute pain episodes associated with sickle cell disease (SCD) are very difficult to manage effectively. Opioid tolerance and side effects have been major roadblocks in our ability to provide these patients with adequate pain relief. This pilot study is designed to examine the safety and feasibility of using ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, in the inpatient seeing with children and adolescents who have sickle cell vasoocclusive pain. Previous research suggests that in subanesthetic doses, ketamine may be able to prevent the development of opiate tolerance and facilitate better pain relief with lower opiate doses, allowing for less respiratory depression, less sedation, easier ambulation, less deconditioning, shorter hospital stays, and better quality of life. The goal of this pilot study is to evaluate the safety and feasibility of using a continuous infusion of ketamine, in conjunction with opiates, in the inpatient setting for sickle cell vasoocclusive pain. It is hypothesized that using a low dose ketamine infusion in conjunction with opiates will be a safe and feasible practice for the treatment of sickle cell pain.
Detailed Description
3.2 Study Design/Type Patient meeting inclusion/exclusion criteria is enrolled up to 24 hours after admission for a vasoocclusive episode. Prior to onset of ketamine infusion, the following information is collected: Demographic information (age, gender, SCD genotype, past history of SCD-related complications) [Obtained from the patient's medical chart] Opiate utilization/hour since admission [Obtained from the patient's medical chart] Numerical Rating Scale (NRS) scores since admission [Obtained from the patient's medical chart] Sedation score (University of Michigan Sedation Scale) is obtained [By the nursing staff] Body outline figure of the Adolescent Pediatric Pain Tool (validated down to age 7) is administered [By the research staff] Ketamine Effects Scale (KES) is administered to the patient [By the research staff] Ketamine infusion is begun at 0.05 mg/kg/hour. After infusion is initiated: Vital signs are taken every hour for two hours after infusion begins, then after two hours, then every four hours for the remainder of the hospitalization [Completed by the nursing staff] Pain scores are recorded with vital signs if the patient is awake [Completed by nursing staff] Patient is also asked if pain is a lot better, a little better, no change, a little worse, or a lot worse than previous assessment [Completed by nursing staff] Sedation score (University of Michigan Sedation Scale) assessed with pain score [Completed by the nursing staff] Adolescent Pediatric Pain Tool (APPT) body outline figure is completed by the patient once per day between 3 pm and 5 pm. [Administered by the research staff] Ketamine Effects Scale (KES) is administered to the patient once per day between 3pm and 5pm [By the research staff] Patient is monitored for side effects including dreams, disorientation, dysphoria, agitation, CNS depression, respiratory depression, increasing hypoxia, nausea, or vomiting [Completed by the nursing or research staff] Need for supplemental oxygen is recorded (oxygen saturation <95%) [Completed by nursing staff] Opiate use and NSAID use/6 hours is recorded [Completed by the nursing or research staff] The infusion may be discontinued or decreased at any time due to unacceptable side effects as determined by the clinician, patient, parent, or principal investigator. Agents designed to reduce ketamine side effects [midazolam (Versed), clonidine, lorazepam (Ativan), or diazepam (Valium)] may be administered at the discretion of the attending physician or the principal investigator. 4 hours or more after infusion begins, the infusion rate may be increased to 0.1 mg/kg/hour if the following parameters are met: patient's pain has not improved to an acceptable range (pain score is still ≥5) side effects remain acceptable 4 hours or more after the previous increase the ketamine infusion may be increased to 0.15 mg/kg/hour per parameters. 4 hours of more after the previous increase the ketamine infusion may be increased to 0.2 mg/kg/hour per parameters. The ketamine infusion will be discontinued at the time of transition to oral pain medication, or no more than 72 hours after initiation, or at the request of the clinician, patient, parent, or principal investigator. Pain scores, vital signs, sedation score, opiate use, APPT body outline figure, and KES score will be recorded as above for the remainder of the hospitalization. Total length of hospitalization will be recorded. Patient will be contacted on a weekly basis for 4 weeks following hospitalization for review of potential side effects, pain episodes, or events leading to re-admission. The patient's medical record will be reviewed to determine duration of previous hospitalizations for SCD pain in the previous 24 months and opiate utilization, pain scores, and transition to oral opiates during those hospitalizations. 3.3 Randomization This will be conducted as a pilot study; patients will not be randomized. 3.4 Duration The length of the patient's participation in this study is the duration of their hospitalization, as well as 4 weeks worth of follow-up phone calls. 3.5 Discontinuation Individual patients will stop receiving ketamine if they develop acute chest syndrome (ACS), have a stroke, are transferred to the Intensive Care Unit (ICU), if their hemoglobin falls below 5 mg/dl, if they experience unacceptable side effects, or at the request of the PI, attending, patient, or parent. However, they will continue to be in the study and all data will be collected throughout the duration of their hospitalization. The entire trial will be terminated when 20 patients have completed the protocol, or if there is an unexpected rate of acute chest syndrome or admissions to the pediatric intensive care unit (PICU).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Sickle Cell Disease
Keywords
ketamine, vasoocclusive pain

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
3 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Ketamine
Arm Type
Experimental
Arm Description
This group will receive ketamine
Intervention Type
Drug
Intervention Name(s)
ketamine
Other Intervention Name(s)
Ketalar
Intervention Description
Medication administered via IV. This study will utilize 4 doses of ketamine: 0.05 mg/kg/hr, 0.1 mg/kg/hr, 0.15 mg/kg/hr, and 0.2 mg/kg/hr. Dosing Regimen: Patients begin the ketamine infusion at 0.05 mg/kg/hr. 4 or more hrs after infusion is started, the dose may be increased to 0.1 mg/kg/hr if: patient's pain has not improved to an acceptable level side effects remain acceptable 4 hrs or more after the previous increase, the dose may be adjusted to 0.15 mg/kg/hr 4 hrs or more after the previous increase, the dose may be adjusted to 0.2 mg/kg/hour Maximum dose of ketamine is limited to 300 mg per 24 hrs Patient may receive ketamine up to 72 hrs after initiation.
Primary Outcome Measure Information:
Title
Number of Participants With Improvement in Pain Scores of >2 Points on the Pain Scale
Description
Determine if there is an apparent improvement in pain control with the ketamine infusion based on the investigator's discretion and comparison to past pain scores. Pain was scored on a scale from 0 to 10. Zero equaled no pain and 10 equaled a lot of pain.
Time Frame
Baseline then daily while inpatient, up to 72 hours
Secondary Outcome Measure Information:
Title
Number of Participants Who Showed a Reduction of Opioid Utilization While on IV Ketamine
Description
Looking at the reduction of opioid utilization while on IV Ketamine. Three participants were enrolled in the study, therefore a comprehensive analysis could not be done due to the low enrollment.
Time Frame
Baseline then daily while inpatient, up to 72 hours

10. Eligibility

Sex
All
Minimum Age & Unit of Time
7 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: CCMC: Children ages 7-22 years (inclusive) with documented sickle cell disease UCHC: Adults 18 years (inclusive) and above with documented sickle cell disease Sudden onset of acute pain consistent with a vasoocclusive episode -Pain requiring hospitalization, placement on pain protocol, and patient- controlled opiates Pain score of greater than or equal to 5 out of 10 when ketamine infusion is started Cognitive ability to report pain on a 0 to 10 Numerical Rating Scale (NRS) At least one prior hospitalization for vasoocclusive pain at CCMC in the previous 24 months Parental consent and child assent Exclusion Criteria: Children hospitalized for a primary diagnosis other than vasoocclusive episode Concurrent Acute Chest Syndrome (ACS) Hemoglobin < 5 mg/dL Concurrent history of glaucoma or raised intracranial pressure Signs or symptoms consistent with stroke History of liver or renal dysfunction Pregnancy (females age 12 and above must have pregnancy test) Simultaneous participation in investigational drug study Primary language spoken other than English No hospitalizations to CCMC for vasoocclusive pain in the previous 24 months
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
William T Zempsky, MD
Organizational Affiliation
Connecticut Children's Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Connecticut Health Center
City
Farmington
State/Province
Connecticut
ZIP/Postal Code
06030
Country
United States
Facility Name
Connecticut Children's Medical Center
City
Hartford
State/Province
Connecticut
ZIP/Postal Code
06106
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
There is no plan to share data as the low enrollment makes the results of this study non-generalizable.

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Low-Dose Ketamine Infusion for Children With Sickle Cell Disease-Related Pain

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