Pre-hospital management of pain associated with an acute sickle cell crisis

Sickle Cell Disease and its acute manifestation as a sickle cell crisis has a severely deleterious effect on predicted mortality and quality of life of its sufferers. Serious sequelae can occur, resulting in severe neurological and cardiovascular impairment. In the majority of cases these patients will present to pre-hospital clinicians with acute intractable pain unmanaged by the patient's own analgesia. Unfortunately, some evidence reports that pain is commonly under-treated with assumptions made about drug-seeking behaviour. The evidence presented in this paper will indicate that Entonox should no longer be routinely used for the management of sickle cell pain. Instead, emphasis should turn to the use of potent intravenous opiates (where intravenous access can be reliably and aseptically gained). The use of diamorphine and ketamine for extreme pain should be investigated by pre-hospital services, as should the use of non-steroidal anti-inflammatory drugs.

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