Intravenous narcotic therapy for children with severe sickle cell pain crisis
T. B. Cole, R. H. Sprinkle, S. J. Smith and G. R. Buchanan
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.
