Reply to the Letter to the Editor.

Dear Editor,

We thank Dr. Raghuraman MS for his valuable comments on our manuscript titled “Ketamine for sickle cell vaso-occlusive crises: A systematic review”, and would like to add clarifications.

We do acknowledge that the included studies had substantial heterogeneity in terms of comparative arms, indications for the use, dosage, and groups of patients included, which was also the reason a meta-analysis could not be performed.

The efficacy and safety of ketamine analgesic sub-dissociative dose has been proven in multiple clinical trials, but few such studies included sickle cell disease (SCD) patients with vaso-occlusive painful crises (VOC). The conclusion of our systematic review that inadequate evidence was available to confirm the efficacy and safety of ketamine was only based on that indication. Nonetheless, since the publication of the systematic review, a large randomized trial has been published that assessed the efficacy and safety of ketamine compared to morphine in adult SCD patients with VOC who presented to the emergency department. The primary outcome of this study was the mean difference in the Numerical Pain Rating scale score over 2 h: no difference was noted between the two groups. However, a meaningful pain reduction in the ketamine arm with no increase in drug-related adverse effects, led the authors to conclude that ketamine is an effective analgesic in SCD patients with VOC with a good safety profile.[1]

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Conflicts of interest

There are no conflicts of interest.