• Mohammed S Alshahrani, Amal H AlSulaibikh, Mohamed R ElTahan, Sukayna Z AlFaraj, Laila P Asonto, Abdullah A AlMulhim, Murad F AlAbbad, Nisreen Almaghraby, Mohammed A AlJumaan, Thamir O AlJunaid, Moath N Darweesh, Faisal M AlHawaj, Alaa M Mahmoud, Bader K Alossaimi, Shaikhah K Alotaibi, Talal M AlMutairi, Duaa A AlSulaiman PharmD, Dunya Alfaraj, Reem Alhawwas, Lawrence Mbuagbaw, Kim Lewis, Madeleine Verhovsek, Mark Crowther, Gordon Guyatt, Waleed Alhazzani, and GUIDE Group.
• Emergency and Critical Care Departments, King Fahad Hospital of the University-Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia.
• Acad Emerg Med. 2022 Feb 1; 29 (2): 150-158.

ObjectiveThe objective was to evaluate the efficacy and safety of single-dose ketamine infusion in adults with sickle cell disease (SCD) who presented with acute sickle vasoocclusive crisis (VOC).MethodsThis study was a parallel-group, prospective, randomized, double-blind, pragmatic trial. Participants were randomized to receive a single dose of either ketamine or morphine, infused over 30 min. Primary outcome was mean difference in the numerical pain rating scale (NPRS) score over 2 h. NPRS was recorded every 30 min for a maximum of 180 min and secondary outcomes were cumulative dose of opioids, emergency department (ED) length of stay, hospital admission, change in vital signs, and drug-related side effects. Authors performed the analysis using intention-to-treat principle.ResultA total of 278 adults with SCD and who presented with acute sickle VOC participated in this trial. A total of 138 were allocated to the ketamine group. Mean (±standard deviation [SD]) NPRS scores over 2 h were 5.7 (±2.13) and 5.6 (±1.90) in the ketamine and morphine groups. The ketamine group received significantly lower cumulative doses of morphine during their ED stay (mean ± SD = 4.5 ± 4.6 mg) than of the morphine group (mean ± SD = 8.5 ± 7.55 mg). Both groups had similar rates of hospital admission: 6.3% in the ketamine group had drug-related side effects compared to 2.2% in the morphine group.ConclusionEarly use of ketamine in adults with VOC resulted in a meaningful reduction in pain scores over a 2-h period and reduced the cumulative morphine dose in the ED with no significant drug-related side effects in the ketamine-treated group.© 2021 The Authors. Academic Emergency Medicine published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine.

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