Opioid patient controlled analgesia use during the initial experience with the IMPROVE PCA trial: A phase III analgesic trial for hospitalized sickle cell patients with painful episodes
Open Access
- 29 August 2011
- journal article
- letter
- Published by Wiley in American Journal of Hematology
- Vol. 86 (12), E70-E73
- https://doi.org/10.1002/ajh.22176
Abstract
Opioid analgesics administered by patient-controlled analgesia (PCA)are frequently used for pain relief in children and adults with sickle cell disease (SCD) hospitalized for persistent vaso-occlusive pain, but optimum opioid dosing is not known. To better define PCA dosing recommendations,a multi-center phase III clinical trial was conducted comparing two alternative opioid PCA dosing strategies (HDLI—higher demand dose with low constant infusion or LDHI—lower demand dose and higher constant infusion) in 38 subjects who completed randomization prior to trial closure. Total opioid utilization (morphine equivalents,mg/kg) in 22 adults was 11.6 ± 2.6 and 4.7 ± 0.9 in the HDLI andin the LDHI arms, respectively, and in 12 children it was 3.7 ± 1.0 and 5.8 ± 2.2, respectively. Opioid-related symptoms were mild and similar in both PCA arms (mean daily opioid symptom intensity score: HDLI0.9 ± 0.1, LDHI 0.9 ± 0.2). The slow enrollment and early study termination limited conclusions regarding superiority of either treatment regimen. This study adds to our understanding of opioid PCA usage in SCD. Future clinical trial protocol designs for opioid PCA may need to consider potential differences between adults and children in PCA usage.Keywords
This publication has 15 references indexed in Scilit:
- Importance of Side Effects in Opioid Treatment: A Trade-Off Analysis With Patients and PhysiciansThe Journal of Pain, 2010
- The effect of intravenous opioid patient-controlled analgesia with and without background infusion on respiratory depression: A meta-analysisJournal of Opioid Management, 2010
- Newer Aspects of the Pathophysiology of Sickle Cell Disease Vaso-OcclusionHemoglobin, 2009
- Patient‐controlled analgesia versus continuous infusion of morphine during vaso‐occlusive crisis in sickle cell disease, a randomized controlled trialAmerican Journal of Hematology, 2007
- Clinically Significant Differences in the Visual Analog Pain Scale in Acute Vasoocclusive Sickle Cell CrisisHemoglobin, 2007
- Outcome of Sickle Cell AnemiaMedicine, 2005
- Reliability and Validity of the Perioperative Opioid-Related Symptom Distress ScaleAnesthesia & Analgesia, 2004
- A comparison of two regimens of patient-controlled analgesia for children with sickle cell diseaseJournal of Pediatric Nursing, 1998
- COMPARISON OF PATIENT-CONTROLLED ANALGESIA WITH AND WITHOUT A BACKGROUND INFUSION AFTER LOWER ABDOMINAL SURGERY IN CHILDRENBritish Journal of Anaesthesia, 1993
- The development of a short opiate withdrawal scale (SOWS)Addictive Behaviors, 1990