Inpatient management of sickle cell pain: a 'snapshot' of current practice.

Abstract:

:The Sickle Cell Disease Clinical Research Network (SCDCRN) designed the PROACTIVE Feasibility Study (ClinicalTrials.gov NCT00951808) to determine whether elevated serum levels of secretory phospholipase A2 (sPLA2) during hospitalization for pain would permit preemptive therapy of sickle cell acute chest syndrome (ACS) by blood transfusion. While PROACTIVE was not designed to assess pain management and was terminated early due to inadequate patient accrual, collection of clinical data allowed a "snapshot" of current care by expert providers. Nearly half the patients admitted for pain were taking hydroxyurea; hydroxyurea did not affect length of stay. Providers commonly administered parenteral opioid analgesia, usually morphine or hydromorphone, to adults and children, generally by patient-controlled analgesia (PCA). Adult providers were more likely to prescribe hydromorphone and did so at substantially higher morphine equivalent doses than were given to adults receiving morphine; the latter received doses similar to children who received either medication. All subjects treated with PCA received higher daily doses of opioids than those treated by time-contingent dosing. Physicians often restricted intravenous fluids to less than a maintenance rate and underutilized incentive spirometry, which reduces ACS in patients hospitalized for pain.

journal_name

Am J Hematol

authors

Miller ST,Kim HY,Weiner D,Wager CG,Gallagher D,Styles L,Dampier CD,Investigators of the Sickle Cell Disease Clinical Research Network (SCDCRN).

doi

10.1002/ajh.22265

subject

Has Abstract

pub_date

2012-03-01 00:00:00

pages

333-6

issue

3

eissn

0361-8609

issn

1096-8652

journal_volume

87

pub_type

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