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Master Thesis

La kétamine dans les douleurs réfractaires en oncologie pédiatrique : étude prospective observationnelle

Abstract : Pain control is a challenge in children with cancer. Consequences of disease progression, central sensitization and side effects of painkillers like opioids induced hyperalgesia can lead to intractable pain despite well conducted treatments. Ketamine, a N Methyl D Aspartate receptor antagonist, has shown to be efficient in relieving cancer pain in adult population. Literature regarding children is scarce. This prospective multicentric observational study (CNIL and CCTRIS approved) aims to assess efficiency, safety and opioid-sparing effect of low doses of ketamine added to pain medication to improve refractory cancer pain in children. Thirty-eight patients (median age 15y) from 10 French pediatric oncology centers were registered during a 11 months period. All received Ketamine either intravenously (37) or orally (1) as adjuvant treatment of refractory pain. Forty-eight hours after initiation of ketamine, VAS scores were significantly reduced by at least two points in 19 (56%) patients. Nine patients experienced poor tolerance (at least 2 side effects such as nightmares, nausea…), all with infusion rates lower than 0,05 mg/kg/h. None had limiting toxicities. Concomitant prescription of benzodiazepine has not shown efficiency in controlling side effects. Opioid-sparing effect was highlighted in four patients. Forty-seven percent of the patients found ketamine adjunction “really helpful” even those who did not experienced improvement of pain control. The adjunction of low doses of ketamine to opioids analgesics in children suffering from refractory cancer pain allowed reducing intensity of pain in half of our population study. However we can’t conclude to an efficacy using the statistical design beforehand established. Nevertheless, Ketamine may be an interesting and safe option for improving treatment of refractory pain in children with cancer.
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Master Thesis
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Submitted on : Friday, September 18, 2015 - 5:25:57 PM
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  • HAL Id : dumas-01202115, version 1


Magali Courade. La kétamine dans les douleurs réfractaires en oncologie pédiatrique : étude prospective observationnelle. Médecine humaine et pathologie. 2015. ⟨dumas-01202115⟩