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Postoperative morphine consumption in children with sickle-cell disease
Mark W Crawford1, Seth Galton, Basem Naser
1Department of Anesthesia, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. mark.crawford@sickkids.ca
Insights
Children with sickle-cell disease require significantly more morphine and experience greater pain after surgery than non-sickle cell children. This leads to longer hospital stays for sickle cell patients, highlighting a critical need for tailored pain management strategies.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Hematology
Background:
- Effective pain management is crucial in perioperative care for sickle-cell disease patients.
- Understanding analgesic needs is key to improving outcomes.
Purpose of the Study:
- To compare postoperative morphine consumption and pain scores in pediatric patients with and without sickle-cell disease undergoing laparoscopic cholecystectomy.
Main Methods:
- Retrospective review of medical records for pediatric patients receiving patient-controlled analgesia (PCA) post-laparoscopic cholecystectomy.
- Data collected included morphine consumption, pain scores (visual analogue scale), and perioperative outcomes.
Main Results:
- Sickle-cell disease patients consumed over double the morphine compared to non-sickle-cell patients (1.58 vs. 0.65 mg/kg).
- Sickle-cell patients reported higher pain scores initially and required longer PCA use (51 vs. 21 hours).
- Postoperative hospital stay was significantly longer for sickle-cell patients (3.4 vs. 1.5 days).
Conclusions:
- Pediatric patients with sickle-cell disease require substantially more analgesia and experience prolonged pain postoperatively.
- These findings suggest multifactorial origins, potentially involving pain perception, opioid response, and psychosocial factors.
- Results underscore the need for specialized pain management protocols for sickle-cell disease patients undergoing surgery.
Background:
Effective pain control is a primary goal in the perioperative management of patients with sickle-cell disease. To understand analgesic requirements better, the authors compared postoperative morphine consumption and pain scores in sickle and non-sickle children who had undergone laparoscopic cholecystectomy.
Methods:
We reviewed the medical records of all sickle and non-sickle children referred to the Acute Pain Service of a tertiary care teaching hospital for patient-controlled analgesia (PCA) following laparoscopic cholecystectomy from 1996 to 2003. Data collected included postoperative morphine consumption, visual analogue pain scores, and perioperative outcome.
Results:
Total postoperative morphine consumption in sickle children (n = 12) (1.58 +/- 0.78 mg.kg(-1)) was more than double when compared with non-sickle children (n = 10) (0.65 +/- 0.32 mg.kg(-1)) (P < 0.005). Duration of PCA use among sickle children (51 +/- 25 h) was more than double when compared with non-sickle children (21 +/- 11 h) (P < 0.005). Sickle patients had greater pain scores in the initial 24 h after surgery (P < 0.05) and used more adjuvant analgesics (P < 0.05). Duration of postoperative hospital stay was 3.4 +/- 1.6 days and 1.5 +/- 0.5 days for sickle and non-sickle children, respectively (P < 0.005).
Conclusions:
Sickle children self-administered more than double the amount of morphine, reported more intense pain, and remained hospitalized for more than twice as long as nonsickle children undergoing the same surgical procedure. These findings probably have a multifactorial origin, and might be attributable in part to alterations in pain perception, opioid pharmacokinetics, opioid tolerance, and psychosocial variables.
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