Erhan Elvan, Inal Mehmet T, Aydinok Yesim, Balkan Can, Yegul Ibrahim
Departments of Algology and Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey.
Paediatr Anaesth. 2007 Jan;17(1):84-6. doi: 10.1111/j.1460-9592.2006.02030.x.
We present the analgesic management of a 4-year-old child who suffered from severe abdominal and leg pain during his first vaso-occlusive crisis with sickle cell disease, diagnosed as beta/S disease when he was 1 year old. His mother and father were carriers of beta-thalassemia and hemoglobin S, respectively. He had an upper respiratory tract infection in which a vaso-occlusive crisis was precipitated. On admission to hospital, fever, severe abdominal and leg pain were noted. Hemoglobin was 4 g x dl(-1) with accompanying prominent reticulocytosis and acute spleen enlargement. These findings indicated a sequestration crisis as well as vaso-occlusive disease. He was transfused with packed red cells. Paracetamol (40-60 mg x kg(-1) x day(-1)) and ibuprofen (20 mg x kg(-1) x day(-1)) were administered to relieve pain. The child experienced moderate to severe pain (Oucher score 60-80) despite nonopioid analgesics, so a tramadol infusion (0.25 mg x kg(-1) x h(-1)) was started. During the tramadol infusion no morphine was required, the intensity of pain gradually decreased (Oucher score 20) and the child was able to move his legs. At the end of 3 days splenomegaly regressed, no fever and pain were observed and the infusion was stopped. In conclusion, tramadol infusion i.v. (0.25 mg x kg(-1) x h(-1)) combined with nonopioids was effective to relieve moderate to severe pain due to vaso-occlusive crisis and can be recommended before using morphine in a pediatric sickle cell crisis.
我们介绍了一名4岁儿童的镇痛管理情况。该儿童患有镰状细胞病，在首次血管闭塞性危机期间出现严重腹痛和腿痛，1岁时被诊断为β/S病。他的母亲和父亲分别是β地中海贫血和血红蛋白S的携带者。他患了上呼吸道感染，进而引发了血管闭塞性危机。入院时，发现有发热、严重腹痛和腿痛。血红蛋白为4 g/dl（-1），伴有明显的网织红细胞增多和急性脾肿大。这些发现表明存在脾隔离危机以及血管闭塞性疾病。给他输注了浓缩红细胞。给予对乙酰氨基酚（40 - 60 mg/kg（-1）/天（-1））和布洛芬（20 mg/kg（-1）/天（-1））以缓解疼痛。尽管使用了非阿片类镇痛药，该儿童仍经历中度至重度疼痛（奥ucher评分60 - 80），因此开始静脉输注曲马多（0.25 mg/kg（-1）/小时（-1））。在输注曲马多期间，不需要使用吗啡，疼痛强度逐渐降低（奥ucher评分20），孩子能够活动双腿。3天后脾肿大消退，未观察到发热和疼痛，于是停止了输注。总之，静脉输注曲马多（0.25 mg/kg（-1）/小时（-1））联合非阿片类药物可有效缓解血管闭塞性危机引起的中度至重度疼痛，在小儿镰状细胞危机中使用吗啡之前可推荐使用。
