Intravenous Ketamine Infusion as an Adjuvant to Morphine in a 2-Year-Old With Severe Cancer Pain From Metastatic Neuroblastoma

• DOI: 10.1097/01.mph.0000140656.96085.2c
• Publication Date: 2004-09-28T08:12:02Z
• Authors: Ban C. H Tsui; Dawn Davies; Sunil Desai; Stephan Malherbe
• Keywords: Hallucinations; Morphine; Codeine; Palliative Care; Administration, Oral; Analgesics, Non-Narcotic; Pain, Intractable; 3. Good health; Analgesics, Opioid; Neuroblastoma; Dyspnea; Fatal Outcome; Child, Preschool; Quality of Life; Humans; Drug Therapy, Combination; Female; Ketamine; Infusions, Intravenous; Methadone

A 2.8-year-old female patient (11.6 kg) was admitted to the hospital for uncontrolled pain and swelling in left leg relating a metastatic neuroblastoma. Initially, her managed with oral morphine 2 mg (approx. 0.2 mg/kg) every 4 hours. Because she quite somnolent but still significant pain, analgesia then changed methadone 1 orally 6 hours (approximately 0.1 mg/kg/dose) eventually increased over 36 mg/kg/dose). She received 0.6 0.05 as needed breakthrough pain. continued have severe experienced side effects, including respiratory depression, sedation, visual hallucinations, vomiting. An intravenous ketamine infusion started at 100 μg/kg/hour. Regular opioid administration ceased, given 0.5 0.75 required only zero three doses of per day, initially. After starting infusion, control improved symptoms toxicity abated. more alert able partake limited activities. As result from progressive disease, 200 μg/kg/hour after days positive results. Her condition deteriorate. initiated weeks 50 One week later, died reasonable control. This case illustrates use an effective analgesic adjuvant setting pediatric advanced poorly controlled cancer Ketamine not eased child's suffering while preserving life also quality by maintaining ability communicate engage