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Drug therapy
Intranasal diamorphine for acute sickle cell pain
  1. P Telfer1,
  2. J Criddle2,
  3. J Sandell3,
  4. F Davies4,
  5. I Morrison5,
  6. J Challands6
  1. 1
    Department of Paediatric Haematology and Oncology, Children’s Hospital, Barts and The London NHS Trust, London, UK
  2. 2
    Paediatric Emergency Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
  3. 3
    Paediatric Emergency Department, Poole Hospital NHS Trust, London, UK
  4. 4
    Emergency Department, University Hospitals of Leicester NHS Trust, London, UK
  5. 5
    Paediatric Emergency Department, Children’s Hospital, Barts and The London NHS Trust, London, UK
  6. 6
    Department of Paediatric Anaesthetics, Children’s Hospital, Barts and The London NHS Trust, London, UK
  1. Correspondence to Paul Telfer, Department of Paediatric Haematology and Oncology, Children’s Hospital, Barts and The London NHS Trust, London, UK; paul.telfer{at}bartsandthelondon.nhs.uk

Abstract

The painful crisis is the commonest acute presentation of sickle cell disease (SCD), yet effective pain control in hospital is often delayed, inadequate and dependent on injected opiates. Intranasal diamorphine (IND) has been used in paediatric emergency departments for management of acute pain associated with fractures, but the analgesic effect is short lived. We evaluated its efficacy and safety when given in combination with intravenous or oral morphine for rapid analgesia for children presenting to our emergency department with painful crisis of SCD. In phase 1, nine patients received IND plus intravenous morphine. In phase 2, 13 received IND plus oral morphine. There was a rapid improvement in pain score; the proportions in severe pain at t = 0, 15, 30 and 120 minutes in phase 1 were 78%, 11%, 0% and 11%, respectively; in phase 2, 77%, 30%, 15% and 0%, respectively. There were no serious side effects and questionnaire scores indicated that children found IND effective and acceptable. IND can be recommended for acute control of sickle pain in children presenting to hospital.

https://doi.org/10.1136/adc.2008.138875

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    Footnotes

    • Competing interests None declared.

    • Ethics approval The study was approved by the institutional Ethics Committee.

    • Contributions PT designed the protocol, analysed the results and wrote the manuscript. IM, FD, JS and JC undertook the evaluation of intranasal diamorphine in the Paediatric Emergency Department at The Royal London Hospital.

    • Provenance and peer review Not commissioned; externally peer reviewed.