{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T16:04:10Z","timestamp":1771257850215,"version":"3.50.1"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,8,4]],"date-time":"2022-08-04T00:00:00Z","timestamp":1659571200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pain Res."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>In this study, we aim to evaluate the efficacy of adjunctive lidocaine and ketamine infusions for opioid reduction in the treatment of sickle cell disease in patients with vaso-occlusive crisis (VOC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>We retrospectively reviewed a cohort of 330 adult sickle-cell crisis hospital encounters with 68 patients admitted to our institution from July 2017 to August 2018.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Upon institutional IRB approval, we obtained initial data from billing records and performed chart reviews to obtain pain scores and confirm total opioid consumption. If provided by the acute pain consultation service, the patients received either a lidocaine or a ketamine infusion of 0.5\u20132 mg\/min or 2\u20133 mcg\/kg, respectively, for a maximum of 24\u201348 h. We compared the change in opioid consumption before and after infusion therapy to patients that did not receive ketamine or lidocaine.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Compared to patients that did not receive infusion therapy, ketamine and lidocaine accounted for respective relative decreases of 28 and 23% in average daily morphine consumption (<jats:italic>p<\/jats:italic> = 0.02). Patients that received either infusion were 3 to 4 times more likely to decrease their opioid consumption independent of treatment length or baseline opioid doses (<jats:italic>p<\/jats:italic> &amp;lt; 0.01). Ketamine and lidocaine therapies were not associated with change in pain scores. When a patient had multiple admissions, opioid reduction was strongly correlated with initiation of infusions in the later visits.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Both ketamine and lidocaine infusion therapies are effective in reducing opioid consumption for patients with vaso-occlusive crisis. Lidocaine infusion is emerging as an agent for stabilizing opioid doses in VOC for patients with high daily MME.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpain.2022.878985","type":"journal-article","created":{"date-parts":[[2022,8,4]],"date-time":"2022-08-04T05:09:48Z","timestamp":1659589788000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Lidocaine and Ketamine Infusions as Adjunctive Pain Management Therapy: A Retrospective Analysis of Clinical Outcomes in Hospitalized Patients Admitted for Pain Related to Sickle Cell Disease"],"prefix":"10.3389","volume":"3","author":[{"given":"Nicolas A.","family":"Zavala","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Randall W.","family":"Knoebel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Magdalena","family":"Anitescu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,8,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3447","DOI":"10.1182\/blood-2009-07-233700","article-title":"Improved survival of children and adolescents with sickle cell disease","volume":"115","author":"Quinn","year":"2010","journal-title":"Blood."},{"key":"B2","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1016\/j.jpain.2016.12.016","article-title":"AAPT diagnostic criteria for chronic sickle cell disease pain","volume":"18","author":"Dampier","year":"2017","journal-title":"J Pain"},{"key":"B3","doi-asserted-by":"publisher","first-page":"3647","DOI":"10.1182\/blood-2012-04-383430","article-title":"Sickle cell pain: a critical reappraisal","volume":"120","author":"Ballas","year":"2012","journal-title":"Blood."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1001\/jama.2014.10517","article-title":"Management of sickle cell disease: summary of the 2014 evidence-based report by expert panel members","volume":"312","author":"Yawn","year":"2014","journal-title":"JAMA."},{"key":"B5","doi-asserted-by":"publisher","first-page":"94","DOI":"10.7326\/0003-4819-148-2-200801150-00004","article-title":"Daily assessment of pain in adults with sickle cell disease","volume":"148","author":"Smith","year":"2008","journal-title":"Ann Intern Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"243","DOI":"10.5055\/jom.2015.0273","article-title":"Daily home opioid use in adults with sickle cell disease: the PiSCES project","volume":"11","author":"Smith","year":"2015","journal-title":"J Opioid Manag."},{"key":"B7","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1016\/j.annemergmed.2008.07.050","article-title":"Comparisons of high versus low emergency department utilizers in sickle cell disease","volume":"53","author":"Aisiku","year":"2009","journal-title":"Ann Emerg Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1016\/j.jpsychores.2018.12.010","article-title":"Central sensitization in chronic pain and medically unexplained symptom research: a systematic review of definitions, operationalizations and measurement instruments","volume":"117","author":"den Boer","year":"2019","journal-title":"J Psychosom Res"},{"key":"B9","article-title":"Incidence and risk factors for development of persistent postsurgical pain following total knee arthroplasty: a retrospective cohort study","volume-title":"Medicine","author":"Gungor","year":"2019"},{"key":"B10","doi-asserted-by":"publisher","first-page":"994","DOI":"10.1016\/j.jpain.2019.03.001","article-title":"Are signs of central sensitization in acute low back pain a precursor to poor outcome?","volume":"20","author":"Klyne","year":"2019","journal-title":"J Pain"},{"key":"B11","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1097\/SPC.0000000000000262","article-title":"Ketamine for cancer pain: what is the evidence?","volume":"11","author":"Jonkman","year":"2017","journal-title":"Curr Opin Support Palliat Care."},{"key":"B12","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1213\/ANE.0000000000004185","article-title":"Ketamine infusions for chronic pain: a systematic review and meta-analysis of randomized controlled trials","volume":"129","author":"Orhurhu","year":"2019","journal-title":"Anesth Analg."},{"key":"B13","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1213\/ANE.0000000000001787","article-title":"Intravenous ketamine infusions for neuropathic pain management: a promising therapy in need of optimization","volume":"124","author":"Maher","year":"2017","journal-title":"Anesth Analg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1016\/j.jemermed.2016.12.039","article-title":"The use of ketamine for acute treatment of pain: a randomized, double-blind, placebo-controlled trial","volume":"52","author":"Sin","year":"2017","journal-title":"J Emerg Med."},{"key":"B15","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1016\/j.ajem.2014.12.058","article-title":"Low-dose ketamine vs morphine for acute pain in the ED: a randomized controlled trial","volume":"33","author":"Miller","year":"2015","journal-title":"Am J Emerg Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1097\/AJP.0b013e3181b511ab","article-title":"Use of low-dose ketamine infusion for pediatric patients with sickle cell disease-related pain: a case series","volume":"26","author":"Zempsky","year":"2010","journal-title":"Clin J Pain."},{"key":"B17","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1016\/S0034-7094(10)70041-6","article-title":"Intraoperative intravenous lidocaine","volume":"60","author":"de Oliveira","year":"2010","journal-title":"Rev Bras Anestesiol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1250","DOI":"10.1002\/phar.2189","article-title":"Intravenous lidocaine for acute pain: a systematic review","volume":"38","author":"Masic","year":"2018","journal-title":"Pharmacotherapy."},{"key":"B19","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1213\/00000539-199802000-00003","article-title":"Intravenous lidocaine speeds the return of bowel function, decreases postoperative pain, and shortens hospital stay in patients undergoing radical retropubic prostatectomy","volume":"86","author":"Groudine","year":"1998","journal-title":"Anesth Analg."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1050","DOI":"10.1213\/01.ANE.0000104582.71710.EE","article-title":"Perioperative intravenous lidocaine has preventive effects on postoperative pain and morphine consumption after major abdominal surgery","volume":"98","author":"Koppert","year":"2004","journal-title":"Anesth Analg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"105","DOI":"10.15441\/ceem.15.103","article-title":"Intravenous lidocaine for the treatment of acute pain in the emergency department","volume":"3","author":"Fitzpatrick","year":"2016","journal-title":"Clin Exp Emerg Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"359","DOI":"10.3109\/15360288.2015.1082009","article-title":"Intravenous lidocaine as an adjuvant for pain associated with sickle cell disease","volume":"29","author":"Nguyen","year":"2015","journal-title":"J Pain Palliat Care Pharmacother."},{"key":"B23","doi-asserted-by":"publisher","first-page":"940","DOI":"10.1093\/aje\/kwg074","article-title":"Estimating the relative risk in cohort studies and clinical trials of common outcomes","volume":"157","author":"McNutt","year":"2003","journal-title":"Am J Epidemiol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1016\/j.hoc.2017.08.009","article-title":"Sickle cell disease in the emergency department","volume":"31","author":"Lovett","year":"2017","journal-title":"Hematol Oncol Clin North Am."},{"key":"B25","doi-asserted-by":"publisher","first-page":"949535","DOI":"10.1100\/2012\/949535","article-title":"Beyond the definitions of the phenotypic complications of sickle cell disease: an update on management","volume":"2012","author":"Ballas","year":"2012","journal-title":"ScientificWorld J."},{"key":"B26","doi-asserted-by":"publisher","first-page":"e27420","DOI":"10.1002\/pbc.27420","article-title":"Impact of early analgesia on hospitalization outcomes for sickle cell pain crisis","volume":"65","author":"Payne","year":"2018","journal-title":"Pediatr Blood Cancer."},{"key":"B27","doi-asserted-by":"publisher","first-page":"800","DOI":"10.1002\/ajh.21832","article-title":"Beneficial effects of nitric oxide breathing in adult patients with sickle cell crisis","volume":"85","author":"Head","year":"2010","journal-title":"Am J Hematol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/j.abb.2011.03.013","article-title":"Nitric oxide reduces sickle hemoglobin polymerization: potential role of nitric oxide-induced charge alteration in depolymerization","volume":"510","author":"Ikuta","year":"2011","journal-title":"Arch Biochem Biophys."},{"key":"B29","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1001\/jama.2011.235","article-title":"Nitric oxide for inhalation in the acute treatment of sickle cell pain crisis: a randomized controlled trial","volume":"305","author":"Gladwin","year":"2011","journal-title":"JAMA."},{"key":"B30","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1038\/pr.2017.197","article-title":"Patient characteristics affect the response to ketamine and opioids during the treatment of vaso-occlusive episode-related pain in sickle cell disease","volume":"83","author":"Nobrega","year":"2018","journal-title":"Pediatr Res."},{"key":"B31","doi-asserted-by":"publisher","first-page":"684","DOI":"10.1111\/pan.12172","article-title":"Low-dose ketamine as a potential adjuvant therapy for painful vaso-occlusive crisis in sickle cell disease","volume":"23","author":"Neri","year":"2013","journal-title":"Paediatr Anaesth."},{"key":"B32","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1097\/SPC.0000000000000437","article-title":"Ketamine and lidocaine infusions decrease opioid consumption during vaso-occlusive crisis in adolescents with sickle cell disease","volume":"13","author":"Puri","year":"2019","journal-title":"Curr Opin Support Palliat Care."},{"key":"B33","doi-asserted-by":"publisher","first-page":"e29215","DOI":"10.1002\/pbc.29215","article-title":"Lidocaine infusions and reduced opioid consumption-Retrospective experience in pediatric hematology and oncology patients with refractory pain","volume":"68","author":"Anghelescu","year":"2021","journal-title":"Pediatr Blood Cancer."},{"key":"B34","doi-asserted-by":"publisher","first-page":"e29693","DOI":"10.1002\/pbc.29693","article-title":"Low-dose ketamine infusions reduce opioid use in pediatric and young adult oncology patients","volume":"4","author":"Anghelescu","year":"2022","journal-title":"Pediatr Blood Cancer."}],"container-title":["Frontiers in Pain Research"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpain.2022.878985\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,4]],"date-time":"2022-08-04T05:09:51Z","timestamp":1659589791000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpain.2022.878985\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,4]]},"references-count":34,"alternative-id":["10.3389\/fpain.2022.878985"],"URL":"https:\/\/doi.org\/10.3389\/fpain.2022.878985","relation":{},"ISSN":["2673-561X"],"issn-type":[{"value":"2673-561X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,4]]},"article-number":"878985"}}