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Early vs delayed opioid administration for pediatric sickle cell vaso-occlusive crisis: A systematic review and

Ayesha Khalid1, Alexandra Salazar Riaño2, Jonathan D Mohnkern3

  • 1Pediatrics, Marshall University Joan C. Edward College of Medicine, Huntington, WV, United States of America.

The American Journal of Emergency Medicine
|May 26, 2026
PubMed

Insights

Early versus delayed opioid administration in pediatric sickle cell vaso-occlusive episodes (VOE) showed no significant differences in hospital admission, emergency department discharge, length of stay, or pain reassessment outcomes.

Area of Science:

  • Pediatric Emergency Medicine
  • Hematology
  • Pharmacology

Background:

  • Sickle cell disease (SCD) frequently causes vaso-occlusive events (VOE) leading to acute pain and emergency department (ED) visits in children.
  • Limited data exists on optimal timing for opioid administration in pediatric SCD VOE.
  • This study addresses the critical need for evidence-based guidelines on timely pain management.

Purpose of the Study:

  • To systematically review and meta-analyze studies comparing early versus delayed opioid administration in pediatric patients experiencing VOE.
  • To evaluate the impact of opioid timing on key clinical outcomes.

Main Methods:

  • Systematic literature search of PubMed, Embase, and Cochrane Library up to November 2025.
  • Included randomized controlled trials and observational studies following PRISMA guidelines.
  • Meta-analysis of outcomes including hospital admission, ED discharge, ED length of stay, and pain reassessment.

Main Results:

  • Six studies with 3367 pediatric patients were analyzed.
  • No significant differences were found in hospital admission, ED discharge, ED length of stay, or pain reassessment between early and delayed opioid groups.
  • Subgroup analysis and individual study findings suggested potential benefits of timely repeat dosing and intranasal fentanyl.

Conclusions:

  • Current evidence indicates no significant difference in major clinical outcomes when comparing early versus delayed opioid administration for pediatric sickle cell VOE.
  • Further research may explore specific interventions like intranasal fentanyl for pain management.
  • Findings support a re-evaluation of current ED protocols for pediatric SCD pain management.
Abstract

Keywords:
Expert consensusOpioid analgesiaPediatric emergency medicineSickle cell diseaseVaso-occlusive crisismeta-analysis

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