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Intravenous Narcotic Therapy for Children With Severe Sickle Cell Pain Crisis

Intravenous Narcotic Therapy for Children With Severe Sickle Cell Pain Crisis Abstract • 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 (98 painful episodes) 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 (including special attention directed to avoiding dosing error), continuous intravenous narcotic infusions are safe and provide effective pain relief for severe sickle cell pain crisis. (AJDC 1986;140:1255-1259) References 1. Dean J, Schechter AN: Sickle-cell anemia: Molecular and cellular bases of therapeutic approaches . N Engl J Med 1978;299:804-811, 863-870.Crossref 2. Vichinsky EP, Lubin BH: Sickle cell anemia and related hemoglobinopathies . Pediatr Clin North Am 1980;27:429-447. 3. Vichinsky EP, Johnson R, Lubin BH: Multidisciplinary approach to pain management in sickle cell disease . Am J Pediatr Hematol Oncol 1982;4:328-338. 4. Bray RJ: Postoperative analgesia provided by morphine infusion in children . Anaesthesia 1983;38:1075-1078.Crossref 5. Miser AW, Miser JS, Clark BS: Continuous intravenous infusion of morphine sulfate for control of severe pain in children with terminal malignancy . J Pediatr 1980;96:930-932.Crossref 6. Nahata MC, Miser AW, Miser JS, et al: Analgesic plasma concentrations of morphine in children with terminal malignancy receiving a continuous subcutaneous infusion of morphine sulfate to control severe pain . Pain 1984;18:109-114.Crossref 7. Mather LE, Meffin PJ: Clinical pharmacokinetics: Pethidine . Clin Pharm 1978;3:352-368.Crossref 8. Williams WD, Chung H: Protein binding diminishes the efficacy of meperidine . Blood 1985;66( (suppl 1) ):67a. 9. Pearson H: Sickle cell syndromes and other hemoglobinopathies , in Miller DR, Pearson HA, Baehner RL, et al (eds): Blood Diseases of Infancy and Childhood , ed 5. St Louis, CV Mosby Co, 1984, pp 416-424. 10. Beutler E: The sickle cell diseases and related disorders , in Williams WJ, Beutler E, Ersler AJ, et al: (eds): Hematology , ed 3. New York, McGraw-Hill International Book Co, 1983, pp 583-609. 11. Wintrobe MM, Lee GR, Boggs DR, et al (eds): Clinical Hematology , ed 8. Philadelphia, Lea & Febiger, 1981, pp 835-868. 12. Wang WC, Parker U, George SL, et al: Transcutaneous electrical nerve stimulation (TENS) treatment of sickle cell painful crisis . Blood 1985;66( (suppl 1) ):67a. 13. Zeltzer L, Dash J, Holland JP: Hypnotically induced pain control in sickle cell anemia . Pediatrics 1979;64:533-536. 14. Co LL, Schmitz H, Havdala H, et al: Acupuncture: An evaluation in the painful crises of sickle cell anaemia . Pain 1979;7:181-185.Crossref 15. Goodman LS, Gilman A: The Pharmacological Basis of Therapeutics , ed 5. New York, Macmillan Publishing Co Inc, 1970. 16. Tang R, Shimomura SK, Rotblatt M: Meperidine-induced seizures in sickle cell patients . Hospital Formulary 1980;15:764-772. 17. McGee JL, Alexander MR: Phenothiazine analgesia: Fact or fantasy? Am J Hosp Pharm 1979;36:633-640. 18. Stambaugh JE, Wainer IW: Drug interaction: Meperidine and chlorpromazine, a toxic combination . J Clin Pharmacol 1981;21:140-146.Crossref 19. Church JJ: Continuous narcotic infusions for relief of postoperative pain . Br Med J 1979;1: 977-979.Crossref 20. Miller RR, Jick H: Clinical effects of meperidine in hospitalized medical patients . J Clin Pharmacol 1978;18:180-187.Crossref 21. Sprinkle RH, Cole T, Smith SJ, et al: Acute chest syndrome in pediatric patients with sickle cell disease: A retrospective analysis of 100 hospitalized patients . Am J Pediatr Hematol Oncol 1986;8:105-110. 22. Poncz M, Kane E, Gill FM: Acute chest syndrome in sickle cell disease: Etiology and clinical correlates . J Pediatr 1985;107:861-866.Crossref 23. Palmer J, Broderick KA, Naiman JL: Acute lung syndrome during painful sickle cell crisis: Relation to site of pain and narcotic requirement . Blood 1983;62( (suppl 1) ):59a. 24. Davies SC, Luce PJ, Win AA, et al: Acute chest syndrome in sickle cell disease . Lancet 1984;1:36-38.Crossref 25. Mather L, Mackie J: The incidence of postoperative pain in children . Pain 1983;15:271-282.Crossref 26. Newburger PE, Sallan SE: Chronic pain: Principles of management . J Pediatr 1981;98: 180-189.Crossref 27. Marks RM, Sachar EJ: Undertreatment of medical inpatients with narcotic analgesics . Ann Intern Med 1973;78:173-181.Crossref 28. Angell M: The quality of mercy . N Engl J Med 1982;306:98-99.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Intravenous Narcotic Therapy for Children With Severe Sickle Cell Pain Crisis

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Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1986.02140260057025
Publisher site
See Article on Publisher Site

Abstract

Abstract • 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 (98 painful episodes) 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 (including special attention directed to avoiding dosing error), continuous intravenous narcotic infusions are safe and provide effective pain relief for severe sickle cell pain crisis. (AJDC 1986;140:1255-1259) References 1. Dean J, Schechter AN: Sickle-cell anemia: Molecular and cellular bases of therapeutic approaches . N Engl J Med 1978;299:804-811, 863-870.Crossref 2. Vichinsky EP, Lubin BH: Sickle cell anemia and related hemoglobinopathies . Pediatr Clin North Am 1980;27:429-447. 3. Vichinsky EP, Johnson R, Lubin BH: Multidisciplinary approach to pain management in sickle cell disease . Am J Pediatr Hematol Oncol 1982;4:328-338. 4. Bray RJ: Postoperative analgesia provided by morphine infusion in children . Anaesthesia 1983;38:1075-1078.Crossref 5. Miser AW, Miser JS, Clark BS: Continuous intravenous infusion of morphine sulfate for control of severe pain in children with terminal malignancy . J Pediatr 1980;96:930-932.Crossref 6. Nahata MC, Miser AW, Miser JS, et al: Analgesic plasma concentrations of morphine in children with terminal malignancy receiving a continuous subcutaneous infusion of morphine sulfate to control severe pain . Pain 1984;18:109-114.Crossref 7. Mather LE, Meffin PJ: Clinical pharmacokinetics: Pethidine . Clin Pharm 1978;3:352-368.Crossref 8. Williams WD, Chung H: Protein binding diminishes the efficacy of meperidine . Blood 1985;66( (suppl 1) ):67a. 9. Pearson H: Sickle cell syndromes and other hemoglobinopathies , in Miller DR, Pearson HA, Baehner RL, et al (eds): Blood Diseases of Infancy and Childhood , ed 5. St Louis, CV Mosby Co, 1984, pp 416-424. 10. Beutler E: The sickle cell diseases and related disorders , in Williams WJ, Beutler E, Ersler AJ, et al: (eds): Hematology , ed 3. New York, McGraw-Hill International Book Co, 1983, pp 583-609. 11. Wintrobe MM, Lee GR, Boggs DR, et al (eds): Clinical Hematology , ed 8. Philadelphia, Lea & Febiger, 1981, pp 835-868. 12. Wang WC, Parker U, George SL, et al: Transcutaneous electrical nerve stimulation (TENS) treatment of sickle cell painful crisis . Blood 1985;66( (suppl 1) ):67a. 13. Zeltzer L, Dash J, Holland JP: Hypnotically induced pain control in sickle cell anemia . Pediatrics 1979;64:533-536. 14. Co LL, Schmitz H, Havdala H, et al: Acupuncture: An evaluation in the painful crises of sickle cell anaemia . Pain 1979;7:181-185.Crossref 15. Goodman LS, Gilman A: The Pharmacological Basis of Therapeutics , ed 5. New York, Macmillan Publishing Co Inc, 1970. 16. Tang R, Shimomura SK, Rotblatt M: Meperidine-induced seizures in sickle cell patients . Hospital Formulary 1980;15:764-772. 17. McGee JL, Alexander MR: Phenothiazine analgesia: Fact or fantasy? Am J Hosp Pharm 1979;36:633-640. 18. Stambaugh JE, Wainer IW: Drug interaction: Meperidine and chlorpromazine, a toxic combination . J Clin Pharmacol 1981;21:140-146.Crossref 19. Church JJ: Continuous narcotic infusions for relief of postoperative pain . Br Med J 1979;1: 977-979.Crossref 20. Miller RR, Jick H: Clinical effects of meperidine in hospitalized medical patients . J Clin Pharmacol 1978;18:180-187.Crossref 21. Sprinkle RH, Cole T, Smith SJ, et al: Acute chest syndrome in pediatric patients with sickle cell disease: A retrospective analysis of 100 hospitalized patients . Am J Pediatr Hematol Oncol 1986;8:105-110. 22. Poncz M, Kane E, Gill FM: Acute chest syndrome in sickle cell disease: Etiology and clinical correlates . J Pediatr 1985;107:861-866.Crossref 23. Palmer J, Broderick KA, Naiman JL: Acute lung syndrome during painful sickle cell crisis: Relation to site of pain and narcotic requirement . Blood 1983;62( (suppl 1) ):59a. 24. Davies SC, Luce PJ, Win AA, et al: Acute chest syndrome in sickle cell disease . Lancet 1984;1:36-38.Crossref 25. Mather L, Mackie J: The incidence of postoperative pain in children . Pain 1983;15:271-282.Crossref 26. Newburger PE, Sallan SE: Chronic pain: Principles of management . J Pediatr 1981;98: 180-189.Crossref 27. Marks RM, Sachar EJ: Undertreatment of medical inpatients with narcotic analgesics . Ann Intern Med 1973;78:173-181.Crossref 28. Angell M: The quality of mercy . N Engl J Med 1982;306:98-99.Crossref

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Dec 1, 1986

References