Management of acute pain in adults with sickle cell disease: the experience of the Clinical Hematology Department of the University of Dakar.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-07-17 eCollection Date: 2024-01-01 DOI:10.55730/1300-0144.5897

Alioune Badara Diallo, Moussa Seck, Mohamed Keita, Sokhna Aissatou Toure, Elimane Seydi Bousso, Baron Ngasia, Blaise Félix Faye, Fatma Dieng, Saliou Diop

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引用次数: 0

Abstract

Background/aim: The evolution of sickle cell disease (SCD) is marked by the occurrence of painful episodes linked to the obstruction of microvessels by sickle cells, known as vaso-occlusive crisis (VOC). The aim of this work was to report the practical aspects of the management of acute pain in adults with SCD. Recommendations based on these practices are also provided.

Materials and methods: This prospective, cross-sectional, descriptive, and analytical study was conducted over a four-month period of all sickle cell patients admitted to emergency departments for VOC. The parameters studied were sociodemographic, clinicobiological, therapeutic, and evolutionary.

Results: There were 118 cases of VOC identified, representing a prevalence of 78.14% of sickle cell emergencies. The mean age of the patients was 28.41 years. The SS sickle cell phenotype accounted for 86.61% of the cases. Osteoarticular pain was the reason for admission for 88.39% of the patients; it was located in the lower limbs in 39.08% and in the spine in 27.1%. Pain intensity was moderate in 6.25% of the patients, intense in 31.25%, and unbearable in 55.55%. Multimodal analgesia was the most commonly used treatment method, combining those of levels one and two (74.31%) and levels one and three (8.25%). The mean dose of morphine administered was 17.14 mg when morphine alone was prescribed for titration, 13.57 mg when paracetamol and morphine were combined, and 15.83 mg when nefopam and morphine were combined. Clinical outcome was favorable in 68.87% of the cases.

Conclusion: Wide variability was observed in the modalities of analgesic treatment of sickle cell VOC. These variations reflect different views on the appropriateness of opioids. This study highlights the efficacy of multimodal analgesia in the management of acute pain in patients with SCD, particularly in regard to morphine sparing. Context-specific recommendations will be needed to harmonize practices.

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镰状细胞病成人患者急性疼痛的处理：达喀尔大学临床血液学系的经验。

背景/目的：镰状细胞病（SCD）的特点是发生与镰状细胞阻塞微血管有关的疼痛发作，即血管闭塞危象（VOC）。这项工作旨在报告成人 SCD 患者急性疼痛管理的实际情况。材料和方法：这项前瞻性、横断面、描述性和分析性研究对所有因 VOC 而被急诊科收治的镰状细胞患者进行了为期四个月的调查。研究参数包括社会人口学、临床生物学、治疗和演变：结果：共发现 118 例 VOC 病例，占镰状细胞急诊发病率的 78.14%。患者的平均年龄为 28.41 岁。SS镰状细胞表型占 86.61%。88.39%的患者因骨关节疼痛入院；39.08%的患者疼痛部位在下肢，27.1%的患者疼痛部位在脊柱。6.25%的患者疼痛程度为中度，31.25%为剧烈，55.55%为无法忍受。多模式镇痛是最常用的治疗方法，包括一级和二级镇痛（74.31%）以及一级和三级镇痛（8.25%）。单用吗啡滴注的平均吗啡剂量为 17.14 毫克，扑热息痛和吗啡合用的平均吗啡剂量为 13.57 毫克，奈福泮和吗啡合用的平均吗啡剂量为 15.83 毫克。68.87%的病例临床结果良好：结论：镰状细胞性血管内皮损伤的镇痛治疗方式存在很大差异。这些差异反映了对阿片类药物适宜性的不同看法。本研究强调了多模式镇痛在治疗 SCD 患者急性疼痛方面的疗效，尤其是在吗啡疏导方面。需要针对具体情况提出建议，以协调各种做法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.