Management of refractory pain in hospitalized adolescents with sickle cell disease: changing from intravenous opioids to continuous infusion epidural analgesia.
J Pediatr Hematol Oncol 2014;
36:e398-402. [PMID:
24136017 DOI:
10.1097/mph.0000000000000026]
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Abstract
BACKGROUND
Prolonged hospitalizations for sickle cell disease painful episodes are not uncommon, as analgesic options are often suboptimal.
OBSERVATIONS
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.
CONCLUSION
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.
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