1114 - Topical Ketamine cream for phantom limb pain in a pediatric patient: a case report

Case Diagnosis: Phantom limb pain in a pediatric patient relieved with topical ketamine cream

Case Description: 12-year-old female was involved in a boating accident that required an AKA. PM&R pain management was consulted for the management of the patient’s phantom limb pain on POD #1. Patient had been on morphine postoperatively but reported continued moderate phantom limb pain and 8/10 pain in the residual limb and incision site. Topical ketamine cream 10% one pump TID was added to her treatment in addition to morphine PCA from the primary team. By POD #3, the patient had been weaned from her morphine PCA and reported no phantom limb pain. Her scheduled pain medications at this time were topical ketamine cream 10%, Motrin, and Neurontin. By discharge on POD #7, the patient had not required any PRN opioids since POD #3.

Discussions: This is a 12-year-old female who was involved in an accident that required an AKA. Postoperatively, the patient complained of phantom limb pain and poorly controlled overall pain. 48 hours after beginning topical ketamine cream treatment, our patient reported significant improvement in her overall pain and complete resolution of her phantom limb pain. To our knowledge, this is the first instance of topical ketamine cream successfully treating phantom limb pain in a pediatric patient without requiring additional opioids.

Conclusions: This is one of the first cases that reports the success of topical ketamine cream in the management of phantom limb pain in a pediatric patient. The patient was successfully discharged with no scheduled opioids. Rehabilitation to follow. Use of topical ketamine cream for phantom limb pain in pediatric patients shows promise, and a thorough study in a pediatric population should be conducted for safety and efficacy.