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Pediatric Rehabilitation

Low Dose Ketamine Infusion Improves Refractory Complex Regional Pain Syndrome 1 in a Pediatric Volleyball Injury: A case report

Friday, October 24, 2025
8:00 AM - 9:15 AM MT
Location: Case Report Theater
Has Audio
Disclosure(s):
Bryan Wacker, DO: No financial relationships to disclose
Jane Anne Emerson, MD: No relevant disclosure to display
Zacharie D. Finneman, DO: No financial relationships to disclose
Case Diagnosis: Complex regional pain syndrome I of the left lower extremity in a pediatric volleyball player

Case Description or Program Description: A 12-year-old female volleyball player suffered a fall with injury to the left knee/ankle resulting in diffuse tenderness, swelling, and inability to bear weight. Orthopedic evaluation and MRI of the knee/ankle were negative for fracture or soft tissue injury. Severe pain continued with inability to bear weight and signs of knee flexion contracture. Orthopedics referred to pediatric PM&R for concerns of complex regional pain syndrome I (CRPS I).

Setting: Pediatric ICU and Inpatient Rehabilitation

Assessment/Results: All initial MRI imaging was non-contributory. PM&R obtained MRA and triple phase bone scan which showed signs of CRPS. Lab work significant for a mildly elevated ANA. When symptoms did not improve, she was admitted to the pediatric floor with plans for inpatient rehabilitation. About 3 months post injury, a low dose ketamine infusion was performed over 7 days with plans for stellate ganglion block if infusion unsuccessful. Starting dose was 0.17 mg/kg/h with titration to 0.4mg/kg/h. She underwent PT and aggressive ROM under conscious sedation and casting of the knee in full extension for 72 hours during the infusion. This was followed by inpatient rehabilitation. She currently exhibits no reliance on assisted devices, improved mood, and lower pain scores. She had significant functional improvements as well. Some pain remains.

Discussion (relevance): Ketamine infusions have been shown to have modest efficacy in the treatment of CRPS. Although frequently studied in the treatment of pain syndromes, there are little to no case reports of ketamine being utilized in children suffering from CRPS

Conclusions: A 7-day ketamine infusion may be an effective treatment for refractory CRPS. Our case report resulted in moderate improvements in pain and a disproportionate improvement in function and ROM. The patient is now ambulatory without assistive devices and has resumed school full time.