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Intravenous narcotic therapy for children with severe sickle cell pain crisis
Insights
Continuous intravenous narcotic infusions effectively manage sickle cell pain crisis. While safe with monitoring, they may require higher doses and cause more side effects than intermittent injections.
Area of Science:
- Pediatrics
- Hematology
- Pain Management
Background:
- Limited research exists on managing pain during sickle cell crises.
- Sickle cell pain crisis requires effective analgesic strategies.
Purpose of the Study:
- To review analgesic management practices for hospitalized children experiencing sickle cell pain crisis.
- To evaluate the efficacy and safety of intravenous narcotic therapy.
Main Methods:
- Retrospective review of 38 pediatric patients (98 painful episodes) over five years.
- Analysis of continuous intravenous narcotic infusions versus intermittent bolus injections.
- Assessment of pain control, narcotic dosage, side effects, and complications.
Main Results:
- Satisfactory pain relief was achieved in all 98 episodes.
- Continuous infusions required higher narcotic doses and led to more side effects (nausea, vomiting, lethargy, abdominal distention) than bolus injections.
- Respiratory depression was uncommon, but chest syndrome was frequent; no narcotic withdrawal or addiction observed.
Conclusions:
- Continuous intravenous narcotic infusions are safe and effective for severe sickle cell pain crisis when carefully monitored.
- A dose-response relationship exists between narcotic dose and side effects.
- Intermittent bolus injections may be associated with fewer side effects.
Abstract:
Few studies have been published about analgesic management practices during sickle cell pain crisis. Therefore, we reviewed the records of all hospitalized children with this complication during a recent five-year period. The 38 patients (98 painful episodes) who received intravenous narcotic therapy were the subjects of this review. In 76 patients, an initial intravenous bolus injection of morphine sulfate or meperidine hydrochloride was followed by a continuous intravenous infusion of one of these two drugs. To achieve adequate pain control, adjustments in infusion rates were made according to a written protocol. In 22 other patients, subsequent narcotic treatment consisted only of intermittent intravenous bolus injections of meperidine. Satisfactory pain relief was achieved in all 98 episodes. Patients given continuous infusions required more narcotic to control their pain and had more side effects than those treated with bolus injections alone, suggesting a dose-response relationship between narcotic dose and several known side effects. Common side effects included nausea and vomiting, lethargy, and abdominal distention. Although clinically evident respiratory depression was quite uncommon, chest syndrome was a frequent complication, and severe respiratory distress occurred in three patients. Narcotic withdrawal or addiction was not observed. With careful monitoring (including special attention directed to avoiding dosing error), continuous intravenous narcotic infusions are safe and provide effective pain relief for severe sickle cell pain crisis.