Sub-dissociative Dose Ketamine in Treatment of Vaso-occlusive Pain Event in Children and Young Adults

• Sub-dissociative Ketamine Infusion (Drug): 0.25 mg/kg of IV ketamine within a 20-minute infusion of 100 milliliters of normal saline (NS)
• Normal Saline Placebo Infusion (Drug): 20-minute infusion of 100 milliliters of normal saline

Primary outcomes

• Total Opioid Medications Required for Analgesia [Up to 3 days]: Cumulative morphine-mg equivalent per kilogram (MME/kg) of opioid medication needed to achieve a pain score of ≤ 5

Secondary outcomes

• Pain Score [30 minutes and 60 minutes after administration of placebo vs ketamine infusion]: Pain score from 0-10, at 30 and 60 minutes after administration of NS/placebo (control group), versus sub-dissociative ketamine (experimental group)
• ED Length of Stay [Up to 3 days]: To compare ED length of stay between control vs experimental group
• Rate of Hospitalization [Up to 1 month]: To compare rate of hospitalization and length of hospitalization between control and experimental group
• Quality of Life (Pediatric Quality of Life) [7-10 days after enrollment in the study and 4-6 weeks after enrollment in the study]: To compare overall quality of life between the two groups upon discharge from the ED or the hospital, using the Pediatric Quality of Life (PedsQL) questionnaire. The questionnaire has 43 points and is reverse scored and linearly transformed to a 0-100 scale (0=100, 1=75, 2=50, 3=25, 4=0), so that higher scores indicate better quality of life.

Sex: All, ages: 5 Years to 20 Years

Inclusion Criteria:

* Between the ages 5-20 years
* Diagnosed sickle cell disease. Homozygous (HbSS) or heterozygous (HbSC, HbSBetaThal Plus or Zero) will be included.
* Presenting with VOE pain, requiring IV pain medication.
* First dose of analgesic medication is given before patient approached for participation in the study.
* Primary language is English or Spanish
* Adult individual or parent/legal guardian is able and willing to provide informed consent. For individuals 7 to 17 years of age, assent must also be provided when cognitively possible.

Exclusion Criteria:

* Sickle cell trait only
* Patients whose primary language is other than English or Spanish
* Pain attributed to causes other than VOE
* Not requiring IV for pain treatment
* No analgesic (e.g. opiate) is given before approach for study participation due to any reason, including problem with IV access.
* Oxygen saturation < 90% on room air
* History of prior adverse reaction to ketamine
* History of hypertension - Patients with active/uncontrolled hypertension defined as systolic 140 mmHg over diastolic of 90 mmHg will be excluded from participation in the study. If hypertension is controlled and at the time of enrollment, systolic and diastolic thresholds of 140 mmHg and 90 mmHg respectively are not exceeded, patient may be included in the study
* History of significant or uncontrolled cardiovascular disease, liver disease, kidney disease, and thyroid disease
* Patients with evidence of increased intracranial pressure
* Patients with elevated intraocular pressure
* Patients with acute mania or history of bipolar disorder with manic episodes, history of hallucinations or paranoia secondary to previously diagnosed psychiatric condition
* Pregnant or potentially pregnant patients per patient report. All patients of childbearing potential will undergo pregnancy testing prior to enrollment (as part of clinical care), and if positive, will be excluded.
* Elevated liver enzymes (alkaline phosphatase, ALT, AST, bilirubin) as sign of hepatic disfunction if the laboratory results are available prior to study participation
* Patients who appear intoxicated on any substance.
* Patients who are wards of the state or prisoners as defined by DHS
* Patients who are not deemed to be competent to provide consent or assent.