Introduction: Sickle cell disease (SCD) is the most common genetic disorder that is prevalent in the African American population, and vaso occlusive crisis(VOC) is a hallmark of SCD, characterized by intense pain and tissue ischemia due to occlusion of small blood vessels by sickled cells. The standard treatment for relieving pain is intravenous opioid administration. However, it has been hypothesized that frequent exposure to opioids in these patients could lead to tolerance, which is thought to contribute to opioid refractory pain. This analysis aims to determine if the use of ketamine in this type of patient is safe and effective when compared with opioids.

Objectives/Methods: Adhering to PRISMA guidelines, a systematic search was initially conducted on 05/20/2024 in PubMed, MEDLINE, Cochrane, Scopus, Web of Science, EMBASE, and CINAHL using the following keywords: ‘Ketamine’, “Sickle cell disease”, and “Vaso-occlusive Crisis. We meticulously included randomized controlled trials (RCT), cohort, case-crossover and case-control studies.

Results: Five studies (689 participants) met the inclusion criteria. Four out of five studies qualitatively reported pain reduction with ketamine. The meta-analysis of two studies (518 observations) for the Numerical Rating Scale (NRS) pain score showed a standardized mean difference (SMD) of -0.11 (95% CI: -0.42 to 0.21, p=0.50, I²=69.7%). For Morphine Milligram Equivalent (MME), two studies (344 observations) yielded an SMD of 0.0043 (95% CI: -1.31 to 1.32, p=0.99, I²=98.5%). Side effects analysis of four studies (608 observations) showed a relative risk (RR) of 5.74 (95% CI: 2.80 to 11.79, p<0.0001, I²=0%).Though the qualitative analysis showed an effective pain reduction with ketamine, there was no statistically significant difference in the numerical pain score reduction analysis.

Conclusion: Our qualitative analysis highlights ketamine's efficacy in VOC to improve pain management with an incidence of dose-dependent side effects. There still needs to be studies on the safety profile of ketamine and standardization of the pain scale. To establish ketamine as a safe and effective treatment for patients with sickle cell disease experiencing a VOC, additional studies are required to increase the statistical power of the research and lead to a definitive conclusion.

Disclosures

No relevant conflicts of interest to declare.

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2024
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