Which Strategy to Manage Severe Vaso-occlusive Crisis in Patients with Sickle Cell Disease in Countries with Limited Healthcare Capacities?

Abstract

We evaluated the treatment of morphine by intravenous patient controlled analgesia versus intermittent subcutaneous routes on patients with sickle cell disease developing severe vaso-occlusivecrisis. Objectives: The primary objective was to compare intravenous patient controlled analgesia (PCA) versus intermittent subcutaneous injection of morphine (SC) on sickle cell patients developing severe vaso-occlusive crisis during the first 24 hours of admission. The secondary objective was to assess the side effects of morphine in both regimens. Methods: A randomized controlled trial of 77 patients in the PCA and 81 in the SC group was conducted at the Sickle Cell Center of Brazzaville in the Republic of Congo. Participants aged from 15 to 45 years old with severe vaso-occlusive crisis were included in the study. Results: Both regimens provided pain relief. However, a significant pain reduction was observed 30 minutes after the administration of morphine in the PCA group (P= 0.001). The mean scores in the PCA and SC regimens were respectively: 1.16±1.40 and 4.30±2.32. The total median dose of morphine administered in the PCA regimen was markedly lower: 24,6±4,16 mg versus 36.6±3.1 mg in the SC group (P=0.01). Morphine administered by PCA provided pain relief during 24 hours while intermittent severe pain was experienced in the SC group (P=0.014). Sedation score S2, S3 was significantly observed in the SC group (P< 0.05).