TY - JOUR
T1 - Intravenous Narcotic Therapy for Children With Severe Sickle Cell Pain Crisis
AU - Cole, T. B.
AU - Sprinkle, R. H.
AU - Smith, S. J.
AU - Buchanan, G. R.
PY - 1986/12
Y1 - 1986/12
N2 - 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 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 continuous intravenous narcotic infusions are safe and provide effective pain relief for severe sickle cell pain crisis.
AB - 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 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 continuous intravenous narcotic infusions are safe and provide effective pain relief for severe sickle cell pain crisis.
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U2 - 10.1001/archpedi.1986.02140260057025
DO - 10.1001/archpedi.1986.02140260057025
M3 - Article
C2 - 3776942
AN - SCOPUS:0022993414
SN - 0002-922X
VL - 140
SP - 1255
EP - 1259
JO - American Journal of Diseases of Children
JF - American Journal of Diseases of Children
IS - 12
ER -