Method A retrospective audit was performed on all admissions with diagnosis of sickle cell pain from January to December 2013. Case notes of 54 patients were reviewed using pre-specified audit criteria. Types of analgesics administered at home and in hospital and pain scores were recorded where available from the case notes.
Results Over the one-year period, 91 admissions were recorded. The average age was 6.6 years (±4.1), with the majority of children (45%) aged between 1 and 5 years. The most prevalent haemoglobinopathy was HbSS (82%). The majority of patients (61%) had a single painful crisis admission, 33% had 2–3 admissions, and the remainder presented with four or more admissions.
Most patients (93%) received one or more analgesics prior to admission. The drug of choice varied, with paracetamol and ibuprofen been the most frequently utilised combination (43%), while 22% received opioids (20% had codeine). Similar to the pre-admission trends, a wide range of analgesics were utilised in hospital with the majority of patients receiving paracetamol and ibuprofen combination (43%). The doses utilised at home were considerably less than those given on admission, suggesting inadequate pain management at home. Codeine was given in 37% of the cases in and it was observed that patients who received codeine had significantly higher initial pain scores on admission compared with those who did not receive codeine. However the administration of codeine did not greatly improve the pain scores and additional step up analgesia was required in 10% of cases who received codeine in hospital.
Conclusion Clear analgesic benefits could not be demonstrated for codeine use with regards to the outcome of efficacy. Although dihydrocodeine is now the weak opioid of choice at our unit added safety measures similar to those with codeine are in place. The audit was limited by poor documentation which have been addressed by the introduction of clearer updated local documents.
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