Sickle cell disease: patient-controlled analgesia was as effective as iv injections.

Clinical bottom line (level 1b-)

  1. In patients with sickle cell disease, patient-controlled analgesia was as safe and effective as intravenous injections in pain control.
Gonzalez et al: Archives of Internal Medicine 1991; 151: 1373-1378
Expires May 2003

The study

Unblinded concealed randomised trial without intention-to-treat
Setting: emergency department, USA

40 patients (aged range 18 to 65 years, ?% male) sickle cell disease

Excluded if
  • history of drug or alcohol abuse
  • allergy to morphine
  • pregnant
  • long-term narcotic use
  • refused to enter


    • Control Group: (n = 20, 20 analysed): intermittent i.v. injections. Phase 1: 4 mg morphine sulphate i.v. every 30-60 minutes to keep analogue score <50 mm; Phase 2: 8 mg morphine sulphate i.v.
    Experimental Group: (n = 20, 20 analysed): patient-controlled analgesia . Phase 1: 2 mg morphine sulphate bolus with 1 mg boost (six minute lockout); Phase 2: 5 mg morphine sulphate bolus with a 2.7 mg boost (10 minute lockout)
    Doses were increased after three hours if pain was not controlled.
    100% followed for 8 hours

    The evidence

    Phase 1
    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    phase 1 linear pain score (0-100 mm) 32.2
    (29.6)     		32.3
    (31.8)     		0.10
    (-20 to 20)
    phase 1 visual pain score (0-10) 3.9
    (2.4)     		3.2
    (2.7)     		-0.70
    (-2.3 to 0.94)

    Phase 2
    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    phase 2 linear pain score 39.5
    (33.8)     		30.5
    (35.7)     		-9.0
    (-31 to 13)
    phase 2 visual pain score 4.2
    (2.7)     		3.6
    (3.4)     		-0.60
    (-2.6 to 1.4)

    Comments

    1. The study was terminated if a patient wanted injections, another analgesic or suffered an adverse reaction.
    2. 77% of nursing staff said that they would use patient-controlled analgesia again.

    Citation

    1. Gonzalez ER, Bahal N, Hansen LA, et al: Intermittent injection versus patient-controlled analgesia for sickle cell crisis pain. Archives of Internal Medicine 1991; 151: 1373-1378
    Contributor: Nick Shenker and Clare Wotton, May 2000
    Reviewer:

    Clinical Question.
    Patient sickle cell disease
    Intervention or Exposure patient-controlled analgesia
    Comparison intermittent i.v. injections
    Outcome pain