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J Pediatr Hematol Oncol. 2020 Jan 17. doi: 10.1097/MPH.0000000000001722. [Epub ahead of print]

Multimodal Analgesic Plan for Children Undergoing Chimeric 14.18 Immunotherapy.

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Department of Anesthesia.
Acute Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University, Montreal, Quebec.
Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL.


Immunotherapy with the chimeric 14.18 anti-GD2 antibody (ch14.18) is associated with severe neuropathic pain. Different analgesic modalities have been employed, but pain management remains challenging and side effects such as desaturation, bradycardia, and hypotension have been reported. We retrospectively analyzed the efficacy of a multimodal regimen based on gabapentin, ketamine, and morphine in controlling pain during ch14.18 chemotherapy. In our cohort, the pain was low, desaturation and hypotension were infrequent, and no episode of bradycardia was reported. Morphine consumption was similar to other studies. Our results suggest that this regimen may be a valid analgesic option in children undergoing ch14.18 infusion.

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