Pain experience of children with sickle cell disease who had prolonged hospitalizations for acute painful episodes.
PURPOSE.: Vaso-occlusive episodes account for 79-91% of emergency room visits and 59-68% of hospitalizations in patients with sickle cell disease (SCD). There is a growing recognition that acute painful experiences can lead to long-term consequences. The purpose of this study was to examine pain management in children who had prolonged (>10 days) hospitalizations for acute painful episodes.


METHODS
Medical records were reviewed to examine: 1) pain intensity ratings; 2) patterns of analgesic use and patient controlled analgesia (PCA) regimen; and 3) differences in pain intensity and pain management between short (< or =10 days) and prolonged (>10 days) hospitalizations for acute painful episodes.


RESULTS
The children reported high pain intensity ratings, which continued throughout hospitalization. The most frequently used medications were morphine delivered using PCA, long-acting morphine, and ketorolac. The total mean amount of morphine administered was 1.16 +/- 0.84 mg/kg/day. The loading and basal rates were administered at doses within the lower range of recommendation. The amount of morphine used was significantly higher during prolonged hospital stays (>10 days) vs short hospital stays (< or =10 days). However, even though the total amount administered was significantly higher during the prolonged (>10 days) hospital stays, the maximum administered amount was on the average only 37% of the prescribed amount on any given day.


CONCLUSIONS
Pain intensity ratings were persistently reported at high to moderate levels. Research is needed to investigate pain management regimens that would lead to optimal relief and minimize the negative consequences associated with painful episodes in children with SCD.
Jacob
Eufemia
E
Baylor College of Medicine, Department of Pediatrics, Clinical Care Center, Houston, Texas, USA. eexjacob@tesaxchildrenshospital.org
Mueller
Brigitta U
BU
D000208:Acute Disease; D000293:Adolescent; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000755:Anemia, Sickle Cell / Q000150:complications*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D002648:Child; D003625:Data Collection; D004632:Emergency Medical Services; D005260:Female; D006760:Hospitalization; D006801:Humans; D008134:Long-Term Care; D008297:Male; D010146:Pain / Q000188:drug therapy / Q000209:etiology* / Q000523:psychology*; D010147:Pain Measurement
D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal