Bolus patient-controlled analgesia with opioids leads to reduced rates of hypoxia, acute chest syndrome, opioid utilization, and a decreased length of stay in the hospital in adolescents with sickle cell disease (SCD), a new study published in Pediatric Blood & Cancer found.

Bolus-only patient-controlled analgesia is successful in managing vaso-occlusive crises, the authors said. “In patients with intractable pain unresponsive to a bolus [patient-controlled analgesia], methadone can provide acute pain control. Superiority of the bolus-only [patient-controlled analgesia] approach needs to be further evaluated in a randomized prospective study.”

Opioids are often used to manage pain caused by vaso-occlusive crises in patients with SCD, however, dosing usually depends on the provider, and these drugs can have serious short- and long-term side effects. Therefore, the minimal effective dose should always be used.

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In the present study, a team of researchers led by Deepa Manwani, MBBS, from the Department of Pediatrics, Children’s Hospital at Montefiore, Albert Einstein College of Medicine in Bronx, New York examined the efficacy of demand-only patient-controlled analgesia in adolescents with SCD.

They evaluated the effect of a clinical practice guideline, which eliminates basal infusion dosing for patient-controlled analgesia upon admission to the hospital.

They found that in cases in which the new clinical practice guideline was implemented, the length of stay in the hospital decreased. The mean total opioid use in morphine equivalents also markedly decreased. Finally, acute chest syndrome and hypoxia both decreased postintervention.

In SCD, sickle-shaped erythrocytes occlude small blood vessels and cause vaso-occlusive crises, which can be very painful. Nonsteroidal anti-inflammatory drugs may be sufficient to manage the pain in some patients, but others do not respond to these and require opioid treatment or hospitalization to treat severe episodes.

Reference

Carullo V, Morrone K, Weiss M, et al. Demand-only patient-controlled analgesia for treatment of acute vaso-occlusive pain in sickle cell disease. Pediatr Blood Cancer. Published online March 16, 2022. doi:10.1002/pbc.29665