Fentanyl Buccal Tablet: A New Breakthrough Pain Medication in Early Management of Severe Vaso-Occlusive Crisis in Sickle Cell Disease.
Background Sickle cell disease ( SCD) is a worldwide distributed hereditary red cell disorder. The principal clinical manifestations of SCD are the chronic hemolytic anemia and the acute vaso-occlusive crisis ( VOCs), which are mainly characterized by ischemic/reperfusion tissue injury. Pain is the...
| Publicado en: | Pain Practice Vol. 16; no. 6; pp. 680 - 688 |
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| Autores principales: | , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Jul2016
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=116527451&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 116527451 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 15307085 HYN jtl: Pain Practice issn: 15307085 maglogo: Y pubinfo: dt: Jul2016 vid: 16 iid: 6 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 116527451 116527451 116527451 10.1111/papr.12313 116527451 ppf: 680 ppct: 8 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Fentanyl Buccal Tablet: A New Breakthrough Pain Medication in Early Management of Severe Vaso-Occlusive Crisis in Sickle Cell Disease. aug: au: De Franceschi, Lucia Mura, Paolo Schweiger, Vittorio Vencato, Elisa Quaglia, Francesca Maria Delmonte, Letizia Evangelista, Maurizio Polati, Enrico Olivieri, Oliviero Finco, Gabriele affil: Department of Medicine, Section of Internal Medicine, University of Verona‐AOUI‐Verona, Verona Italy sug: subj: Anemia, Sickle Cell Complications Fentanyl Therapeutic Use Administration, Buccal Vascular Diseases Physiopathology Human Hereditary Diseases Anemia, Hemolytic Reperfusion Injury Pain Management Crossover Design Analgesia Treatment Outcomes Ketorolac Administration and Dosage Tramadol Administration and Dosage Fentanyl Administration and Dosage Patient Satisfaction Vasoconstriction Pain Drug Therapy Adult Adult: 19-44 years ab: Background Sickle cell disease ( SCD) is a worldwide distributed hereditary red cell disorder. The principal clinical manifestations of SCD are the chronic hemolytic anemia and the acute vaso-occlusive crisis ( VOCs), which are mainly characterized by ischemic/reperfusion tissue injury. Pain is the main symptom of VOCs, and its management is still a challenge for hematologists, requiring a multidisciplinary approach. Methods We carried out a crossover study on adult SCD patients, who received two different types of multimodal analgesia during two separate severe VOCs with time interval between VOCs of at least 6 months. The first VOC episode was treated with ketorolac (0.86 mg/kg/day) and tramadol (7.2 mg/kg/day) ( TK treatment). In the second VOC episode, fentanyl buccal tablet ( FBT; 100 μg) was introduced in a single dose after three hours from the beginning of TK analgesia ( TKF treatment). We focused on the first 24 hours of acute pain management. The primary efficacy measure was the time-weighted-sum of pain intensity differences ( SPID24). The secondary efficacy measures included the pain intensity difference ( PID), the total pain relief ( TOTPAR), and the time-wighted sum of anxiety ( SAID24). Results SPID24 was significantly higher in TKF than in TK treatment. All the secondary measures were significantly ameliorated in TKF compared to TK treatment, without major opioid side effects. Patients satisfaction was higher with TKF treatment than with TK one. Conclusions We propose that VOCs might require breakthrough pain drug strategy as vaso-occlusive phenomena and enhanced vasoconstriction promoting acute ischemic pain component exacerbate the continuous pain of VOCs. FBT might be a powerful and feasible tool in early management of acute pain during VOCs in emergency departments. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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