Management of refractory pain in hospitalized adolescents with sickle cell disease: changing from intravenous opioids to continuous infusion epidural analgesia

• Published in: Journal of pediatric hematology/oncology Vol. 36; no. 6; p. e398
• Main Authors: New, Tamara, Venable, Claudia, Fraser, Laura, Rosenberg, Erin, Schmidt, Jennifer, James-Herry, Anne, Osunkwo, Ifeyinwa, Dampier, Carlton
• Format: Journal Article
• Language: English
• Published: United States 01.08.2014
• Subjects: Administration, Oral; Adolescent; Adolescent, Hospitalized; Analgesia, Epidural - methods; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - adverse effects; Anemia, Sickle Cell - complications; Child; Female; Humans; Infusions, Intravenous; Male; Morphine - administration & dosage; Morphine - adverse effects; Pain, Intractable - drug therapy; Pain, Intractable - etiology; Retrospective Studies; Treatment Outcome
• ISSN: 1536-3678
• DOI: 10.1097/MPH.0000000000000026

Prolonged hospitalizations for sickle cell disease painful episodes are not uncommon, as analgesic options are often suboptimal. Seven patients (15.4 ± 3.7 y, 6 females) were treated with epidural analgesia for refractory pain. The median duration of epidural catheter placement was 4 days (interquartile range, 3 to 6 d). Mean pain scores changed from 6.8 ± 2.7 to 4.8 ± 2.2, whereas mean daily parenteral opioid requirements changed from 79.7 ± 100.4 to 13.0 ± 13.1 mg of morphine equivalents. Continuous epidural analgesia is an alternative to continuing intravenous opioids in sickle cell disease patients with refractory pain, and may reduce opioid-related side effects and facilitate transition to oral analgesics.