Management of acute pain in adults with sickle cell disease: the experience of the clinical hematology department of the university of Dakar

Resumen

Background/aim: The evolution of sickle cell disease (SCD) is marked by the occurrence of painful episodes linked to the obstruction of micro-vessels by sickle cells, known as vaso-occlusive crises (VOC). The aim of our 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: We conducted a prospective, cross-sectional, descriptive and analytical study over a 4-month period of all sickle cell patients admitted to emergency departments for VOC. The parameters studied were sociodemographic, clinico-biological, therapeutic and evolutionary.Results: 118 cases of VOC were 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 cases. Osteoarticular pain was the reason for admission in 88.39% of cases; it was located in the lower limbs in 39.08% of cases and in the spine in 27.1% of cases. Pain intensity was moderate in 6.25% of cases, intense in 31.25% and unbearable in 55.55%. Multimodal analgesia was the most commonly used treatment method, combining levels 1 and 2 (74.31%) and levels 1 and 3 (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 favourable in 68.87% of cases.Conclusion: We noticed a wide variability 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 with regard to morphine sparing. Context-specific recommendations will be needed to harmonize practices.