Pain resulting from sickle-cell vaso-occlusive crisis (VOC) is often severe, prolonged and difficult to alleviate. Guidelines based on scientific evidence are lacking. In order to evaluate the effectiveness of our treatment protocol, we performed a population-based retrospective observational study on HbSS sickle-cell patients (n=22) admitted for severe VOC (n=48) during a 30-months period and managed with patient controlled analgesia (PCA).
Median (10th-90th percentiles) visual analogical pain scale (VAS) at admission was 9.5(7–10). Patient received 0.3mg/kg (0.1–0.4) intravenous morphine at admission, then PCA was started with the following settings: continuous rate: 20 µg/kg/h (10–25), bolus: 25µg/kg (21–32), and 1.8 bolus allowed/hour (1.7–2.8). Six hours after admission, VAS was less than 7 in only 41% of cases. The median VAS declined steadily during hospitalization. Pain intensity was not correlated with morphine dosage. Success 6 hours after admission (VAS< 7) and during hospitalization (VAS£4) was associated with significantly lower VAS score at admission and lower number of VOC during the study period. Patients who experienced >2 CVO/year have the following characteristics: higher VAS at admission, higher morphine dosages, lower success rate and lower CRP, bilirubin, LDH and reticulocyte count.
The difficulties encountered in the management of patients who experienced >2 VOC/year may be related to their genotypic particularities. For such patients, an increase of morphine dosage is required. We have developed a computer routine in order to reduce time and increase accuracy of PCA prescription, and to build a prospective database that enables continuous assessment of our treatment protocol.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.