Which Strategy to Manage Severe Vaso-occlusive Crisis in Patients with Sickle Cell Disease in Countries with Limited Healthcare Capacities?
International Blood Research & Reviews,
We evaluated the treatment of morphine by intravenous patient controlled analgesia versus intermittent subcutaneous routes on patients with sickle cell disease developing severe vaso-occlusivecrisis.
Objectives: The primary objective was to compare intravenous patient controlled analgesia (PCA) versus intermittent subcutaneous injection of morphine (SC) on sickle cell patients developing severe vaso-occlusive crisis during the first 24 hours of admission. The secondary objective was to assess the side effects of morphine in both regimens.
Methods: A randomized controlled trial of 77 patients in the PCA and 81 in the SC group was conducted at the Sickle Cell Center of Brazzaville in the Republic of Congo. Participants aged from
15 to 45 years old with severe vaso-occlusive crisis were included in the study.
Results: Both regimens provided pain relief. However, a significant pain reduction was observed 30 minutes after the administration of morphine in the PCA group (P= 0.001). The mean scores in the PCA and SC regimens were respectively: 1.16±1.40 and 4.30±2.32. The total median dose of morphine administered in the PCA regimen was markedly lower: 24,6±4,16 mg versus 36.6±3.1 mg in the SC group (P=0.01). Morphine administered by PCA provided pain relief during 24 hours while intermittent severe pain was experienced in the SC group (P=0.014). Sedation score S2, S3 was significantly observed in the SC group (P< 0.05).
- Severe pain
- sickle cell disease
- patient controlled analgesia
How to Cite
Rees DC, Williams TN, Gladwin MT. Sickle-cell disease. Lancet. X. Epub. 2010;11;376(9757):2018;31(10):1029- 2010.
World Health Organization. Cancer for pain relief with a guide to opioid availability. Geneva, Switzerland: World Health Organization; 1996.
Uwaezuoke SN, Ayuk AC, Ndu IK, Eneh CI, Mbanefo NR, Ezenwosu OU. Vaso-occlusive crisis in sickle cell disease: Current paradigm on pain management. J Pain Res. 2018;11(11):3141-3150.
Ngolet LO, Moyen Engoba, Elira Dokekias A, Kocko I, Moyen G. Major acute pain complications in congolese children with sickle cell disease. Major acute complications in congolese children with sickle cell disease. MSD. 2016;3(9):320’4.
Al-Anazi A, Al-Swaidan L, Al-Ammari M, Al-Debasi T, Alkatheri AM, Al-Harbi S, et al. Assessment of patient-controlled analgesia versus intermittent opioid therapy to manage sickle-cell disease vaso-occlusive crisis in adult patients. Saudi J Anaesth. 2017;11(4):437-441.
Van Beers EJ, van Tuijn CF, Nieuwkerk PT, Friederich PW, Vranken JH, Biemond BJ. Patient-controlled analgesia versus continuous infusion of morphine during vaso-occlusive crisis in sickle cell disease, a randomized controlled trial. Am J Hematol. 2007;82(11):955-60.
Brandow AM, De Baun MR. Key components of pain management for children and adults with sickle cell disease. Hematol Oncol Clin North Am. 2018; 32(3):535-550.
Al-Anazi A, Al-Swaidan L, Al-Ammari M, Al-Debasi T, Alkatheri AM, Al-Harbi S, et al. Assessment of patient-controlled analgesia versus intermittent opioid therapy to manage sickle-cell disease vaso-occlusive crisis in adult patients. Saudi J Anaesth. 2017;11:437-41.
Walder B, Schafer M, Henzi I, Tramèr MR. Efficacy and safety of patient‑controlled opioid analgesia for acute postoperativepain. A quantitative systematic review. Acta Anaesthesiol Scand. 2001;45:795‑804.
Waldmann CS, Eason JR, Rambohul E, Hanson GC. Serum morphine levels. A comparaison between continuous subcutaneous infusion and continuous intravenous infusion in post- operative patients. Anaesthesia 1984;39: 768-71.
Elsner F, Radbruch L, Loick G, Gaertner J, Sabatowski R. Intravenous versus subcutaneous morphine titration in patients with persisting exacerbation of cancer pain. J Palliat Med. 2005;8(4):743-50.
Al-Anazi A, Al-Swaidan L, Al-Ammari M, Al-Debasi T, Alkatheri AM, Al-Harbi S, Obaidat AA, Al-Bekairy AM. Assessment of patient-controlled analgesia versus intermittent opioid therapy to manage sickle-cell disease vaso-occlusive crisis in adult patients. Saudi J Anaesth. 2017;11 (4):437-441.
Bakır M, Rumeli Atıcı Ş, Yıldırım HU, Tiftik EN, Ünal S. Patient-controlled analgesia and morphine consumption in sickle cell anemia painful crises: A new protocol. Agri. 2020;32(3):115-119.
Hartwig K, Dean M, Hartwig K, Mmbando PZ, Sayed A, de Vries E. Where there is no morphine: the challenge and hope of palliative care delivery in Tanzania. Afr J Prim Health Care Fam Med. 2014; 14;6(1):E1-8.
Rouss K, Gerber A, Albisetti M, Hug M, Bernet V. Long-term subcutaneous morphine administration after surgery in newborns. J Perinat Med. 2007;35(1):79-81.
Merriman A, Mwebesa E, Zirimenya L. Improving access to palliative care for patients with cancer in Africa: 25 years of Hospice Africa. Ecancer medical science. 2019;13:946.
Abstract View: 418 times
PDF Download: 314 times