nalbuphine and Anemia--Sickle-Cell

The most common manifestation of sickle cell disease (SCD) is painful vaso-occlusive episodes (PVOE), and inappropriate treatment leads to unnecessary suffering and potentially fatal complications. This study describes how French paediatric emergency departments (EDs) manage PVOE and their knowledge, and implementation of the French National Authority for Health recommendations on the management of sickle cell patients.. A questionnaire on managing PVOE was sent to all the 111 French paediatric EDs.. We received responses from 81 (72.9%) of the EDs. Of those who responded to each individual question, 85% said that they had read the national recommendations, 71.6% said they used nalbuphine for moderate PVOE, and 85% used intravenous morphine for severe PVOE. The majority (91.7%) of EDs thought that intravenous morphine provided relief for severe PVOE, but only 30.9% thought that intravenous nalbuphine did. A 50:50 nitrous oxide/oxygen mix was used by 71.3% of departments to relieve procedural pain and by 48% to enhance analgesia when morphine was insufficient for severe pain.. Most French EDs follow the national recommendations for PVOE. Nalbuphine was the most commonly used opioid for moderate PVOE and morphine for severe PVOE. A nitrous oxide/oxygen mixture was widely used for PVOE.

Topics: Adolescent; Analgesics; Anemia, Sickle Cell; Child; Emergency Service, Hospital; France; Guideline Adherence; Humans; Morphine; Nalbuphine; Nitrous Oxide; Pain; Practice Patterns, Physicians'; Surveys and Questionnaires

Acute chest syndrome (ACS) represents a serious morbidity and often fatal complication in patients with sickle cell disease. Painful episodes which require hospitalization are most often treated with opioids, which may then influence the development of ACS. Nalbuphine is a parenteral opioid which effectively treats pain and may cause less ACS.. This retrospective chart review documented 988 admissions for painful episodes at 2 institutions and recorded the incidence of ACS and opioid used.. At the Children's Hospital in St Louis, Missouri, the incidence of ACS in patients treated with morphine alone was 10.8% versus at the Children's Mercy Hospital in Kansas City, Missouri, the incidence was 2.1% for patients treated solely with nalbuphine.. When nalbuphine is used alone as the single parenteral opioid agent to treat painful episodes in patients with sickle cell disease, the incidence of ACS is less than when compared with other opioids used to treat pain.

Topics: Acute Disease; Adolescent; Anemia, Sickle Cell; Chest Pain; Child; Child, Preschool; Choice Behavior; Female; Humans; Incidence; Male; Morbidity; Morphine; Nalbuphine; Narcotics; Parents; Retrospective Studies; Young Adult

The hallmark of sickle cell disease (SCD) is recurrent, painful vaso-occlusive episodes (VOC) and is the most common reason for hospitalization in SCD patients. Narcotics, particularly morphine, along with fluid hydration are standard treatments for painful episodes but have been associated with the development of acute pulmonary events commonly referred to as acute chest syndrome (ACS). The development of ACS is often preceded by acute infections, painful episodes, rib infarction, bone marrow infarction, and fat embolism. Its pathophysiology remains multifactorial and has become the most common reason for early mortality. Previous episodes of ACS increase the likelihood of repeated acute pulmonary events and subsequent pulmonary hypertension. Nalbuphine hydrochloride (Nubain) is an opioid with the pain relieving potency of morphine but has not been studied for its association in the development of ACS or compared with morphine in its efficacy of pain control in the sickle cell population.. We reviewed the medical records retrospectively of patients between the age of 5 and 19 years, admitted for vaso-occlusive crisis to the three children's hospitals in Atlanta between January 1999 and December 2002. A computerized search tool was used to identify patients using the International Classification of Diseases Ninth Revision (ICD-9) diagnosis code 282.60 and 282.62. The final discharge diagnosis of ACS was defined as a new pulmonary infiltrate on chest radiograph after admission and before discharge. We calculated the need for 160 patient admissions for 85% power to detect a difference of approximately 20% in incidence of ACS between the two treatment groups.. There were a total of 37 (21%) episodes of ACS. Of these, 26 (29%) were in the morphine group and 11 (12%) were in the Nubain group (P < 0.01). Patients receiving morphine were more likely to have higher white cell counts on admission (P < 0. 05), and to use continuous infusion for medication administration (49% vs. 3%), P < 0. 001. They also had longer hospital stays than patients who received Nubain (median stay 3 days vs. 4 days, morphine), P < 0. 001.. The development of ACS during painful episodes is multi-factorial, but opioid selection may increase this rate. Patients on Nubain were less likely to develop ACS, and they had shorter hospital stays. These results were confounded by use of continuous analgesia infusion with PCA. However, Nubain may provide an alternative to morphine in the treatment of sickle cell pain episodes. A prospective clinical trial comparing these two analgesics would be a preferable next step.

Topics: Acute Disease; Adolescent; Adult; Analgesics, Opioid; Anemia, Sickle Cell; Child; Child, Preschool; Humans; Length of Stay; Lung Diseases; Morphine; Nalbuphine; Pain

Gallbladder stones are very common in patients with sickle cell disease and are the cause of recurrent abdominal pain. Their management has been highly controversial, especially for children. Nonoperated patients and those treated on an emergency basis have a very high rate of morbidity (>50%).. We performed a retrospective review of a series of 29 homozygous SS sickle cell children who underwent laparoscopic cholecystectomy between 1991 and April 1998.. Only in one case a conversion was necessary (early in the series). Exploration of the common bile duct was done via intraoperative cholangiography. There were no mortalities. The morbidity rate was 17%; (however, of the five patients concerned, four suffered from hyperthermia for 2 days. All of the children were improved and enjoyed resolution of their abdominal pain.. We believe that elective laparoscopic cholecystectomy at the earliest time possible, along with correct perioperative management, is the treatment of choice for cholelithiasis in children with sickle cell disease.

Topics: Abdominal Pain; Acetaminophen; Acute Disease; Anemia, Sickle Cell; Child; Child, Preschool; Cholecystectomy, Laparoscopic; Cholecystitis; Cholelithiasis; Female; Humans; Male; Nalbuphine; Pain, Postoperative

The effectiveness of analgesia during sickle cell crisis was examined in this descriptive, exploratory study. Pain scores (using the African-American Oucher and the Adolescent Pediatric Pain Tool) and analgesics administered were examined during a 2-hour observation/interview in the hospital while children/adolescents with sickle cell disease (SCD) experienced a vaso-occlusive episode (VOE). A convenience sample of twenty-one 6- to 16-year olds with SCD was included. Evidence indicated that 15 of the 21 children in the sample were in moderate to severe pain during their interviews, indicating that the analgesics did not effectively control their pain. Most participants (17) had received nalbuphine as the primary analgesic by intravenous infusion drip and/or patient-controlled analgesia pump. Many reasons were identified for the inadequate analgesia. The results suggested that the pain of SCD is very complex, requiring continuous adjustment of comfort measures, especially analgesics. More research is needed to examine pain control in children with SCD.

Topics: Adolescent; Analgesia; Analgesics, Opioid; Anemia, Sickle Cell; Child; Female; Humans; Interviews as Topic; Male; Nalbuphine; Pain; Vascular Diseases

A questionnaire was sent to principal investigators of NIH-sponsored clinical research in sickle cell disease. Twenty of 21 respondents indicated they used parenteral narcotic analgesics for pain episodes sufficiently severe to warrant hospitalization. Eleven used meperidine; seven, morphine; and one each, nalbuphine, hydromorphone, and acetaminophen with codeine. They gave the agents at frequent, regular intervals or by continuous infusion. A total of 41 of more than 3,500 patients required chronic transfusion for pain control. Complications included meperidine-associated convulsions reported by nine respondents and addiction by six. This information indicates that vigorous pain-control methods are used at institutions having a special interest in providing medical care for children with sickle cell disease.

Topics: Acetaminophen; Analgesics; Anemia, Sickle Cell; Child; Child, Preschool; Codeine; Drug Administration Schedule; Drug Combinations; Humans; Hydromorphone; Infant; Length of Stay; Meperidine; Morphine; Nalbuphine; Pain; Pain Management; Seizures

Painful episodes of sickle cell disease remain a source of frustration to patients and health care providers because of the lack of interventions to prevent or control them. Nalbuphine is a potent semisynthetic agonist/antagonist analgesic. We report our experience using nalbuphine as a treatment for painful episodes of sickle cell disease in children. The efficacy of subcutaneous/intramuscular nalbuphine is compared with intramuscular meperidine by a retrospective review of hospitalizations for sickle cell painful episodes. Nalbuphine is as effective as meperidine for the treatment of these episodes. We conclude that nalbuphine is a feasible and effective analgesic and a reasonable treatment option for patients with sickle cell disease experiencing painful episodes.

Topics: Acute Disease; Adolescent; Adult; Anemia, Sickle Cell; Child; Child, Preschool; Female; Humans; Male; Nalbuphine; Pain