Ketamine administration for acute painful sickle cell crisis: A randomized controlled trial Academic Article uri icon

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  • Objective

    The 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).


    This 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.


    A 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.


    Early 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.


  • Alshahrani, Mohammed S
  • AlSulaibikh, Amal H
  • ElTahan, Mohamed R
  • AlFaraj, Sukayna Z
  • Asonto, Laila P
  • AlMulhim, Abdullah A
  • AlAbbad, Murad F
  • Almaghraby, Nisreen
  • AlJumaan, Mohammed A
  • AlJunaid, Thamir O
  • Darweesh, Moath N
  • AlHawaj, Faisal M
  • Mahmoud, Alaa M
  • Alossaimi, Bader K
  • Alotaibi, Shaikhah K
  • AlMutairi, Talal M
  • AlSulaiman PharmD, Duaa A
  • Alfaraj, Dunya
  • Alhawwas, Reem
  • Mbuagbaw, Lawrence
  • Lewis, Kim
  • Verhovsek, Madeleine
  • Crowther, Mark
  • Guyatt, Gordon
  • Al-Hazzani, Waleed

publication date

  • February 2022