Abstract Background Anti‐GD2 antibodies, including naxitamab, are part of standard therapy for high‐risk neuroblastoma (HR‐NB) and are associated with significant pain. We developed a protocol for outpatient use of low‐dose intravenous ketamine (LDIVK) for pain management during naxitamab. We describe the LDIVK protocol and report on its impact on the management of naxitamab‐associated pain. Methods Patients with HR‐NB receiving naxitamab with poorly controlled pain in at least 1 cycle received LDIVK outpatient for subsequent cycles. LDIVK at 0.5 mg/kg/h was started 30 minutes before and ended 1 hour after naxitamab. A retrospective chart review of LDIVK‐treated patients was completed. Intrapatient comparison of vital signs, opioid use, and adverse events between LVIDK‐containing and non‐containing cycles was analyzed using the Wilcoxon signed rank test. Results Twenty‐two pediatric patients received LDIVK at a median age of 6.3 (range, 1–16) years. Twelve patients received the same premedication for cycles with and without LDIVK, and their opioid use was analyzed. Statistically significant reduction in total opioid use in LDIVK‐containing cycle (0.064 mg/kg IV hydromorphone vs. 0.054 mg/kg IV hydromorphone; p = 0.003) and rescue opioid use (0.028 mg/kg IV hydromorphone vs. 0.018 mg/kg IV hydromorphone; p = 0.0042) was noted. There was no significant difference in premedication opioid (0.046 mg/kg IV hydromorphone vs. 0.051 mg/kg IV hydromorphone; p > 0.2). Fluid boluses administered, heart rate, and blood pressure ( p > 0.1 for each) between cycles were the same. One patient experienced dysphoria, which resolved with LDIVK rate reduction. Conclusion Ketamine was successfully administered in an outpatient setting and was associated with a significant opioid‐sparing effect. A larger prospective study is warranted.
Silber et al. (Tue,) studied this question.