Intravenous
morphine is the treatment of choice for severe
pain during vaso- occlusive crisis in
sickle cell disease (SCD). However, side effects of
morphine may hamper effective treatment, and high plasma levels of
morphine are associated with severe complications such as
acute chest syndrome. Furthermore, adequate dosing remains a problem since no objective measurement of
pain severity exists and
analgesia should be titrated upon the patient's reported
pain.
Patient-controlled analgesia (PCA) may therefore be an interesting alternative since patients can titrate the level of
analgesia themselves. In this randomized controlled study, the efficacy of intravenous
morphine administration with PCA was compared with continuous infusion (CI) of
morphine in patients with SCD during vaso-occlusive crisis. Twenty five consecutive episodes of vaso-occlusive crisis in 19 patients with SCD were included in the study. Patients in the PCA-group had a markedly and significant lower mean and cumulative
morphine consumption when compared with the patients in the CI-group (0.5 mg/hr versus 2.4 mg/hr (P < 0.001) and 33 mg versus 260 mg (P = 0.018, respectively). The mean daily
pain scores were comparable (4.9 versus 5.3). The lower mean and cumulative
morphine consumption in the PCA-group led to significant less
nausea and
constipation during treatment when compared with the CI-group (area under the curve, respectively, 11 versus 18 (P = 0.045) and 30 versus 45 (P = 0.021). Furthermore, a nonsignificant reduction in the duration of hospital admission of 3 days was observed in the PCA-group. PCA results in adequate
pain relief at a much lower
morphine consumption and should considered to be the first choice in
morphine administration to sickle cell patients admitted with vaso-occlusive crisis.