Ketamine Infusion as an Adjunct to Opioid Analgesia in Pediatric Patients with High-Risk Neuroblastoma Undergoing Treatment with Dinutuximab: Adverse Effects and Safety in a Non-ICU Setting

Dove Press 2025-01-20

Keri A Streby,1,* Joseph D Tobias,2,3,* Evan McPhaden,4 Shannon Downie,4 Joseph Stanek,1 Catherine Roth,2 Priyal O Patel1,2 1Department of Pediatrics- Division of Pediatric Oncology, Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH, USA; 2Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA; 3Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA; 4Ohio University Heritage College of Osteopathic Medicine, Dublin Campus and Ohio University, Athens, OH, USA*These authors contributed equally to this workCorrespondence: Priyal O Patel, DO Department of Anesthesiology & Pain Medicine Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, Ohio, 43205, USA, Tel +1-(614) 722-3728, Fax +1-(614) 722-4203, Email priyal.patel@nationwidechildrens.orgIntroduction: Anti-GD2 immunotherapy has improved outcomes for children with high-risk neuroblastoma (HRNBL). Dinutuximab promotes complement-mediated reaction against disialoganglioside GD2, which is expressed in peripheral nerves and over-expressed in neuroblastoma. Dinutuximab is associated with ≥grade 3 neuropathic pain. Targeting GD2 stimulates the NMDA receptor, which makes ketamine useful in treatment of associated pain. The objective of this retrospective study is to describe the use of ketamine for pain uncontrolled by opioids, and ketamine’s impact on total opioid usage for patients receiving dinutuximab. In addition, the secondary objective is to describe the toxicities of pain management with opioids versus opioid plus ketamine.Methods: A retrospective chart review of 40 hRNBL patients receiving dinutuximab at Nationwide Children’s Hospital, from 2010 to 2022, was conducted. Demographics, pain scores, medication records, and total daily IV morphine milligram equivalents (IVMME) with and without a ketamine adjunct were co

Journal of Pain Research; Original Research; info:eu-repo/semantics/article

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