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Pain management in fulminating ulcerative colitis
Author(s) -
WHITE MICHELLE,
SHAH NEIL,
LINDLEY KEITH,
LLOYDTHOMAS ADRIAN,
THOMAS MARK
Publication year - 2006
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/j.1460-9592.2006.01913.x
Subject(s) - medicine , ketamine , ulcerative colitis , anesthesia , toxic megacolon , adverse effect , patient controlled analgesia , analgesic , perforation , rectal administration , rectum , surgery , disease , materials science , punching , metallurgy
Summary Background: Toxic megacolon is a life‐threatening complication of ulcerative colitis (UC) characterized by systemic toxicity, loss of blood per rectum and severe pain. Pain management is challenging in these patients because nonsteroidal anti‐inflammatory drugs may exacerbate bleeding and opioids are contraindicated because they adversely affect bowel peristalsis causing an increased risk of colonic perforation. Methods: We describe three episodes of fulminating UC in two children in whom ketamine analgesia was used. Our protocol for a low‐dose continuous ketamine infusion with either nurse‐controlled analgesia (NCA) or patient‐controlled analgesia (PCA) bolus administration is presented and a review of the literature regarding the use of ketamine analgesia in children is discussed. Results: Low‐dose ketamine N/PCA with a continuous background infusion provided satisfactory analgesia and none of our children reported adverse effects. Conclusions: We have demonstrated the safe and effective use of ketamine analgesia in children with toxic megacolon, a condition in which the child is in severe pain and morphine is contraindicated.