Pain management in adults with sickle cell disease in a Medical Center Emergency Department

Adult Sickle Cell Disease Program, Sections of Hematology and Palliative Care, Department of Medicine, Yale University School of Medicine, 333 Cedar St, PO Box 208201, New Haven, CT 06520-8021, USA.
Journal of the National Medical Association (Impact Factor: 0.96). 11/2010; 102(11):1025-32.
Source: PubMed


Guidelines for pain management in adult sickle cell patients with vaso-occlusive crises suggest prompt, frequent administration of parenteral opioids. Neither the ability to implement these guidelines in a busy urban emergency department nor opioid dose requirements in uncomplicated vaso-occlusive crisis have been previously documented. Thus, a retrospective review of vaso-occlusive crisis treated in an urban medical center emergency department in 2005 was performed to define opioid requirements and barriers to guideline implementation. Fifty-seven visits by 19 patients were evaluable. Opioid treatment was not initiated for more than 2 hours during 30% of visits; the interval between the first and second opioid doses exceeded 1 hour in 26% of visits and increased with subsequent doses; and total treatment time was less than 1 hour during 21% of visits (median, 2.2 hours). Opioid doses (as intravenous morphine equivalents) ranged from 4 to 26.7 mg (0.05-0.50 mg/kg) and exceeded 10 mg during 40 visits (70%) and in 10 patients (53%). Hospitalization occurred on 25 occasions with 48% of patients admitted after 3 or fewer opioid doses and 50% of patients admitted after less than 3 hours of treatment. Moreover, return emergency department visits occurred within 3 days after 9 of 32 home discharges (28%) with treatment times uniformly less than 3 hours during the preceding visit. It is concluded that: (1) opioid dose requirements vary widely, often exceeding guideline recommendations; and (2) treatment time and timely opioid administration are often compromised, resulting in delayed pain control and premature decisions on disposition with early return visits and possibly avoidable hospital admissions.

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    • "[4] The hallmark manifestation of pain is related to the vasoocclusion , reperfusion injury and hypoxemia. [31] Hospital admittance to medical-surgical nursing units is seeing an increase in inpatients with SCD and need to be able to appropriately manage their care. [32] 1.2.3 Simulation High-fidelity human patient simulation (HFS) provides an environment that as realistically as possible reflects a clinical setting, offering students an opportunity to enhance diverse learning needs. "

    06/2015; 5(9). DOI:10.5430/jnep.v5n9p39
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    • "Sleep impairment and insomnia in sickle cell disease V. Mann-Jiles et al. (Jennings, Bobb, Noreika, & Coyne, 2013; Solomon, 2010; Tanabe et al., 2012; Telfer et al., 2009), although small sample sizes make it difficult to generalize findings to the sickle cell population. Additional research is necessary to validate innovative pain interventions. "
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    ABSTRACT: PurposeTo examine clinical and psychological indicators associated with sleeplessness and insomnia in adult patients with sickle cell.Data sourcesPubMed, Scopus, Cochrane Library. Data were collected from adult sickle cell participants (N = 72) in outpatient clinics at a Midwest National Cancer Institute designated comprehensive cancer center. A retrospective chart review observed for clinical and psychological indicators associated with sleeplessness and insomnia.Conclusions Findings included that adults with sickle cell experienced insomnia (47%) and sleep impairment (15%). Significant associations existed between pain and sleep impairment (p = .00), insomnia and pain (p = .00), morning hours of sleep (p = .00), and evening hours (p = .00). Pain may contribute to insomnia or interrupt sleep; daytime sleeping was not conducive to nighttime sleep. Anxiolytics, antidepressants, and long-acting opioids were not associated with insomnia (p = .00, p = .43, and p = .10), respectively; reduction in anxiety may reduce insomnia. Long-acting opioids may provide for improved pain control sleep.Implications for practiceHealthcare providers play a pivotal role in the assessment of sleep impairment or disorders. Effective management is necessary for improved quality of life. Further investigation is warranted to understand the meaning of sleep impairment in adult patients with sickle cell with prospective controlled studies to examine the efficacy of interventions.
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