Managing severe pain in children, adolescents, and young adults with oncologic malignancies and sickle cell disease present a challenge to members of the multidisciplinary team. Traditional pain treatment strategies rely primarily on opioid analgesia (Wang, 2015) in addition to complementary therapies to provide comfort. Despite these interventions, many patients report inadequate pain control and adverse effects. These side effects can range from tolerable (pruritis) and dose-dependent (constipation) to life-threatening (respiratory depression, sedation). Refractory pain is a common reason for hospital readmission in this patient population, specifically in patients with sickle cell disease or patients being treated at the end of life. Ketamine, a dissociative anesthetic used for sedation, has traditionally been administered in the operating room or in an intensive care unit (ICU) setting with stringent monitoring parameters. In patients with persistent pain despite traditional analgesic interventions, adjuvant therapy with low-dose ketamine infusions have proven beneficial (Hagedorn, 2016). Low-dose ketamine infusions are associated with opioid-sparing effects, improved pain management, and improvement in the child's ability to interact with their family (Finkel, 2007).
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