the Department of Pharmacy, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA, and the Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
the Department of Pharmacy, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.
J Pain Palliat Care Pharmacother. 2023 Jun;37(2):116-122. doi: 10.1080/15360288.2023.2167035. Epub 2023 Jan 26.
Patient-controlled analgesia (PCA) appears to be the preferred modality for treatment of pain associated with vaso-occlusive crisis (VOC) and is the current standard of therapy at most institutions. With limited data available, this study analyzed the effectiveness of PCA vs intravenous push (IVP) hydromorphone for pain management of VOC. The primary objective was to determine whether PCA or IVP hydromorphone is more effective in controlling VOC pain determined by a reduction in mean absolute difference pain intensity (MPI) from baseline to discharge. This retrospective single-center study evaluated differences in outcomes between patients treated with PCA vs those treated with IVP hydromorphone for VOC during hospital admission. Those 18 years or older admitted with one of the following International Classification of Diseases, Tenth Revision codes were included: D57.0 (Hb-SS disease with crisis), D57.2 (sickle cell/Hb-C disease), and D57.4 (sickle cell thalassemia), and administered PCA or IVP hydromorphone. The observed difference in absolute pain scores were not statistically significant ( = 0.753). The use of IVP hydromorphone resulted in a significant reduction in length of stay (LOS) and morphine milligram equivalent (MME) use compared to PCA, but was associated with a numerical increase in treatment failures. This study was limited by its retrospective nature, uneven distribution of groups, and only reviewed use of IVP and PCA hydromorphone at one institution.
患者自控镇痛（PCA）似乎是治疗血管阻塞性危象（VOC）相关疼痛的首选方式，也是目前大多数机构的治疗标准。由于数据有限，本研究分析了 PCA 与静脉推注（IVP）氢吗啡酮治疗 VOC 疼痛的效果。主要目的是确定 PCA 与 IVP 氢吗啡酮在控制 VOC 疼痛方面是否更有效，以从基线到出院时平均绝对差异疼痛强度（MPI）的降低来衡量。这项回顾性单中心研究评估了在住院期间，接受 PCA 治疗和 IVP 氢吗啡酮治疗的患者之间的结局差异。符合以下国际疾病分类，第十版代码之一的 18 岁或以上患者被纳入研究：D57.0（Hb-SS 疾病伴危象）、D57.2（镰状细胞/血红蛋白 C 疾病）和 D57.4（镰状细胞性地中海贫血），并接受 PCA 或 IVP 氢吗啡酮治疗。观察到的绝对疼痛评分差异没有统计学意义（P=0.753）。与 PCA 相比，IVP 氢吗啡酮的使用显著降低了住院时间（LOS）和吗啡毫克当量（MME）的使用，但与治疗失败的数值增加有关。本研究受到其回顾性、组间分布不均以及仅在一个机构审查 IVP 和 PCA 氢吗啡酮使用的限制。
