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Intermittent Injection vs Patient-Controlled Analgesia for Sickle Cell Crisis Pain: Comparison in Patients in the Emergency Department

Intermittent Injection vs Patient-Controlled Analgesia for Sickle Cell Crisis Pain: Comparison in... Abstract Background.— The purpose of this study is a prospective assessment of morphine sulfate administration by intermittent intravenous (IV) injections (Int-IV) vs patient-controlled analgesia (PCA) in patients in the emergency department (ED) with sickle cell crisis pain. Methods.— Patients were at bed rest and received intravenous hydration. Linear analog scale for pain intensity and verbal pain scale, level of alertness, and vital signs were assessed prior to therapy, every 60 minutes thereafter, and at the time of discharge from the ED. Patients were randomized to Int-IV or PCA. During phase 1, patients in the Int-IV group received morphine sulfate 4 mg IV every 30 to 60 minutes as necessary for a linear analog scale for pain intensity greater than 50 mm. The patients in the PCA group received morphine sulfate 2 mg bolus then 1.0 mg with a 6-minute lockout. During phase 2, patients in the Int-IV group received morphine sulfate 8 mg IV every 30 to 60 minutes as necessary for a linear analog scale for pain intensity greater than 50 mm. The patients in the PCA group received morphine sulfate 5 mg bolus then 2.7 mg with a 10-minute lockout. Data were analyzed by unpaired t test, general linear modeling, MannWhitney U test, and X2 test. Results.— During phase 1, 10 patients (28.3 ±7.3 years) received Int-IV and 10 patients (33.9 ±12.5 years) received PCA. Treatment groups did not differ significantly regarding duration of pain, amount of morphine administered, linear analog scale for pain intensity, verbal pain scale, level of alertness, or vital signs except for a significantly lower final respiratory rate with Int-IV. In phase 2, 12 patients (28.4 ±5.6 years) received Int-IV and 13 patients (26.8 ± 8.1 years) received PCA. The PCA groups had a significantly shorter elapsed time between onset of pain and treatment (7.3 ±6.5 hours) when compared with the Int-IV group (18 ±16.9 hours). Treatment groups did not differ significantly with respect to total amount of morphine administered, linear analog scale for pain intensity, verbal pain scale, vital signs, or level of alertness. The PCA group had a significant reduction in length of stay in the ED during phase 2 when compared with phase 1. The ED discharge rate and the incidence of side effects did not differ significantly between groups. Conclusion.— At both the low- and high-dose regimens, PCA is equally safe and effective and may be used in place of Int-IV administration of morphine in the ED treatment of sickle cell crisis pain.(Arch Intern Med. 1991;151:1373-1378) References 1. Rozzell MS, Hijazi M, Pack B. The painful episode . Nurs Clin North Am. 1983;18:185-199. 2. Brozovic M, Davies SC, Yardumian A, et al. Pain relief in sickle cell crisis . Lancet. 1986;624-625. 3. Powers RD. Management protocol for sickle-cell disease patients with acute pain: impact on emergency department and narcotic use . Am J Emerg Med. 1986;4:267-268.Crossref 4. Welchew EA. On-demand analgesia: a double-blind comparison of on-demand intravenous fentanyl with regular intramuscular morphine . Anesthesia. 1983;38:19-25.Crossref 5. Cintron ML, Johnston-Early A, Boyer M, et al. Patient-controlled analgesia for severe cancer pain . Arch Intern Med. 1986;146:734-736.Crossref 6. Baumann TJ, Batenhorst RL, Graves DA, Foster TS, Bennett RL. Patient-controlled analgesia in the terminally ill cancer patient . DICP. 1986;20:297-301. 7. Graves DA, Foster TS, Batenhorst RL, Bennett RL, Baumann TJ. Patient-controlled analgesia . Ann Intern Med. 1983;99:360-366.Crossref 8. White F. Use of patient-controlled analgesia for management of acute pain . JAMA. 1988;259:243-247.Crossref 9. Schecter NL, Berrien FB, Katz SM. The use of patient controlled analgesia in adolescents with sickle cell crisis pain: a preliminary report . J Pain Symptom Management. 1988;2:109-113.Crossref 10. Batenhorst RL, Maurer HS, Bertch KA, Koshy M, Hyman L. Patient controlled analgesia in uncomplicated sickle cell crisis pain . Blood. 1987;70:558. Abstract. 11. Rapp R, Bivins BA, Littrell RA, Foster TS. Patient-controlled analgesia: a review of effectiveness of therapy and evaluation of currently available devices . DICP. 1898;23:899-904. 12. Jones L, Neiswender JA, Perkins M. PCA: patient satisfaction, nursing satisfaction and cost-effectiveness . Nurs Management. 1989;29:16-17. 13. Shapiro BS. The management of pain in sickle cell disease . Pediatr Clin North Am. 1989;36:1029-1045. 14. Bojanowski C. Use of protocols for ED patients with sickle cell anemia . J Emerg Nurs. 1989;15:83-87. 15. Payne R. Pain management in sickle cell disease: rationale and techniques . Ann N Y Acad Sci. 1989;565:189-206.Crossref 16. Keats AS. Postoperative pain: research and treatment . J Chron Dis. 1956;4:72-83.Crossref 17. Sriwatananakul K, Kelvie W, Lasagna L, Camlimlim JF, Weis OF, Mehta G. Studies with different types of visual analog scales for measurement of pain . Clin Pharmacol Ther. 1983;34:234-239.Crossref 18. Revill SI, Robinson JO, Rosen M, Hogg MIJ. The reliability of a linear analogue for evaluating pain . Anesthesia. 1976;31:1191-1198.Crossref 19. Price DD, McGrath PA, Rafii A, Buckinham B. The validation of visual analog scales as ratio scale measures for chronic and experimental pain . Pain. 1983;17:45-56.Crossref 20. Littman GS, Walker BR, Schneider BE. Reassessment of verbal and visual analog ratings in analgesic studies . Clin Pharmacol Ther. 1985;38:16-23.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Intermittent Injection vs Patient-Controlled Analgesia for Sickle Cell Crisis Pain: Comparison in Patients in the Emergency Department

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1991.00400070131017
Publisher site
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Abstract

Abstract Background.— The purpose of this study is a prospective assessment of morphine sulfate administration by intermittent intravenous (IV) injections (Int-IV) vs patient-controlled analgesia (PCA) in patients in the emergency department (ED) with sickle cell crisis pain. Methods.— Patients were at bed rest and received intravenous hydration. Linear analog scale for pain intensity and verbal pain scale, level of alertness, and vital signs were assessed prior to therapy, every 60 minutes thereafter, and at the time of discharge from the ED. Patients were randomized to Int-IV or PCA. During phase 1, patients in the Int-IV group received morphine sulfate 4 mg IV every 30 to 60 minutes as necessary for a linear analog scale for pain intensity greater than 50 mm. The patients in the PCA group received morphine sulfate 2 mg bolus then 1.0 mg with a 6-minute lockout. During phase 2, patients in the Int-IV group received morphine sulfate 8 mg IV every 30 to 60 minutes as necessary for a linear analog scale for pain intensity greater than 50 mm. The patients in the PCA group received morphine sulfate 5 mg bolus then 2.7 mg with a 10-minute lockout. Data were analyzed by unpaired t test, general linear modeling, MannWhitney U test, and X2 test. Results.— During phase 1, 10 patients (28.3 ±7.3 years) received Int-IV and 10 patients (33.9 ±12.5 years) received PCA. Treatment groups did not differ significantly regarding duration of pain, amount of morphine administered, linear analog scale for pain intensity, verbal pain scale, level of alertness, or vital signs except for a significantly lower final respiratory rate with Int-IV. In phase 2, 12 patients (28.4 ±5.6 years) received Int-IV and 13 patients (26.8 ± 8.1 years) received PCA. The PCA groups had a significantly shorter elapsed time between onset of pain and treatment (7.3 ±6.5 hours) when compared with the Int-IV group (18 ±16.9 hours). Treatment groups did not differ significantly with respect to total amount of morphine administered, linear analog scale for pain intensity, verbal pain scale, vital signs, or level of alertness. The PCA group had a significant reduction in length of stay in the ED during phase 2 when compared with phase 1. The ED discharge rate and the incidence of side effects did not differ significantly between groups. Conclusion.— At both the low- and high-dose regimens, PCA is equally safe and effective and may be used in place of Int-IV administration of morphine in the ED treatment of sickle cell crisis pain.(Arch Intern Med. 1991;151:1373-1378) References 1. Rozzell MS, Hijazi M, Pack B. The painful episode . Nurs Clin North Am. 1983;18:185-199. 2. Brozovic M, Davies SC, Yardumian A, et al. Pain relief in sickle cell crisis . Lancet. 1986;624-625. 3. Powers RD. Management protocol for sickle-cell disease patients with acute pain: impact on emergency department and narcotic use . Am J Emerg Med. 1986;4:267-268.Crossref 4. Welchew EA. On-demand analgesia: a double-blind comparison of on-demand intravenous fentanyl with regular intramuscular morphine . Anesthesia. 1983;38:19-25.Crossref 5. Cintron ML, Johnston-Early A, Boyer M, et al. Patient-controlled analgesia for severe cancer pain . Arch Intern Med. 1986;146:734-736.Crossref 6. Baumann TJ, Batenhorst RL, Graves DA, Foster TS, Bennett RL. Patient-controlled analgesia in the terminally ill cancer patient . DICP. 1986;20:297-301. 7. Graves DA, Foster TS, Batenhorst RL, Bennett RL, Baumann TJ. Patient-controlled analgesia . Ann Intern Med. 1983;99:360-366.Crossref 8. White F. Use of patient-controlled analgesia for management of acute pain . JAMA. 1988;259:243-247.Crossref 9. Schecter NL, Berrien FB, Katz SM. The use of patient controlled analgesia in adolescents with sickle cell crisis pain: a preliminary report . J Pain Symptom Management. 1988;2:109-113.Crossref 10. Batenhorst RL, Maurer HS, Bertch KA, Koshy M, Hyman L. Patient controlled analgesia in uncomplicated sickle cell crisis pain . Blood. 1987;70:558. Abstract. 11. Rapp R, Bivins BA, Littrell RA, Foster TS. Patient-controlled analgesia: a review of effectiveness of therapy and evaluation of currently available devices . DICP. 1898;23:899-904. 12. Jones L, Neiswender JA, Perkins M. PCA: patient satisfaction, nursing satisfaction and cost-effectiveness . Nurs Management. 1989;29:16-17. 13. Shapiro BS. The management of pain in sickle cell disease . Pediatr Clin North Am. 1989;36:1029-1045. 14. Bojanowski C. Use of protocols for ED patients with sickle cell anemia . J Emerg Nurs. 1989;15:83-87. 15. Payne R. Pain management in sickle cell disease: rationale and techniques . Ann N Y Acad Sci. 1989;565:189-206.Crossref 16. Keats AS. Postoperative pain: research and treatment . J Chron Dis. 1956;4:72-83.Crossref 17. Sriwatananakul K, Kelvie W, Lasagna L, Camlimlim JF, Weis OF, Mehta G. Studies with different types of visual analog scales for measurement of pain . Clin Pharmacol Ther. 1983;34:234-239.Crossref 18. Revill SI, Robinson JO, Rosen M, Hogg MIJ. The reliability of a linear analogue for evaluating pain . Anesthesia. 1976;31:1191-1198.Crossref 19. Price DD, McGrath PA, Rafii A, Buckinham B. The validation of visual analog scales as ratio scale measures for chronic and experimental pain . Pain. 1983;17:45-56.Crossref 20. Littman GS, Walker BR, Schneider BE. Reassessment of verbal and visual analog ratings in analgesic studies . Clin Pharmacol Ther. 1985;38:16-23.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jul 1, 1991

References