title: Management of refractory pain in hospitalized adolescents with sickle cell disease: changing from intravenous opioids to continuous infusion epidural analgesia.
abstract: BACKGROUND
  Prolonged hospitalizations for sickle cell disease painful episodes are not uncommon, as analgesic options are often suboptimal.
  
  
  METHODS
  Seven patients (15.4 ± 3.7 y, 6 females) were treated with epidural analgesia for refractory pain. The median duration of epidural catheter placement was 4 days (interquartile range, 3 to 6 d). Mean pain scores changed from 6.8 ± 2.7 to 4.8 ± 2.2, whereas mean daily parenteral opioid requirements changed from 79.7 ± 100.4 to 13.0 ± 13.1 mg of morphine equivalents.
  
  
  CONCLUSIONS
  Continuous epidural analgesia is an alternative to continuing intravenous opioids in sickle cell disease patients with refractory pain, and may reduce opioid-related side effects and facilitate transition to oral analgesics.
authors.affiliation: *Emory University School of Medicine †Children's Healthcare of Atlanta, Atlanta, GA.
authors.forename: Tamara
authors.initials: T
authors.lastname: New
authors.forename: Claudia
authors.initials: C
authors.lastname: Venable
authors.forename: Laura
authors.initials: L
authors.lastname: Fraser
authors.forename: Erin
authors.initials: E
authors.lastname: Rosenberg
authors.forename: Jennifer
authors.initials: J
authors.lastname: Schmidt
authors.forename: Anne
authors.initials: A
authors.lastname: James-Herry
authors.forename: Ifeyinwa
authors.initials: I
authors.lastname: Osunkwo
authors.forename: Carlton
authors.initials: C
authors.lastname: Dampier
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000298:Adolescent, Hospitalized; D015360:Analgesia, Epidural / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000755:Anemia, Sickle Cell / Q000150:complications*; D002648:Child; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D010148:Intractable Pain / Q000188:drug therapy* / Q000209:etiology*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine