Page 101 WHO - Guidelines on the pharmacological treatment of persisting pain in children with medical illness

A2.2.13 Adjuvants in neuropathic pain: ketamine

Clinical question
In children with persisting neuropathic pain, what is the evidence for the use of ketamine as compared
to placebo in order to achieve rapid, effective and safe pain control?

Recommendation
At present, it is not possible to make recommendations regarding the benefits and risks of ketamine as
an adjuvant to opioids for neuropathic pain in children.

Domains and considerations

Quality of evidence
There is limited evidence for ketamine in sub-anaesthetic (low) dose as an adjuvant to strong opioids
in palliative care in adults (88). There are no studies in children investigating the use of ketamine as
an adjuvant to opioid for refractory neuropathic pain.
Uncertainty: yes.

Values and acceptability
In favour
Ketamine in sub-anaesthetic (low) dose may be considered as an adjuvant to opioid for refractory
neuropathic pain.
Against
Unknown
Uncertainty: yes.

Research agenda
Trials concerning the efficacy and safety of sub-anaesthetic (low) dose ketamine as an adjuvant to
opioid in children with refractory neuropathic pain are needed.

A2.2.14 Adjuvants in neuropathic pain: local anaesthetics

Clinical question
In children with persisting neuropathic pain, what is the evidence for the systemic use of local
anaesthetics as compared to placebo in order to achieve rapid, effective and safe pain control?

Recommendations
At present, it is not possible to make recommendations regarding the benefits and risks of the systemic
use of local anaesthetics for persisting neuropathic pain in children.

Domains and considerations

Quality of evidence
No evidence was retrieved for the use of systemic local anaesthetics as adjuvants for pain relief
in children. There is evidence in adults that intravenous lidocaine and its oral analog mexiletine
are more effective than a placebo in decreasing neuropathic pain and can relieve pain in selected
patients (89).
Uncertainty: yes.

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