Management of Severe Intractable Sickle Cell Pain with Intrathecal Opioid Analgesia.

Abstract

Management of severe Sickle Cell Pain (SCP) often entails the utilization of opioids via the intravenous route. In this abstract, we describe the utilization of Intrathecal Morphine Analgesia (IMA) infusion in the management of severe SCP. Two African American women were the subjects of this study: a 50-year-old patient with sickle cell anemia and a 51-year-old patient with sickle-b+-thalassemia. Complications of their disease included frequent acute painful episodes, S/P cholecystectomy, iron overload, and severe avascular necrosis (AVN) of the left hip in the first patient and frequent acute painful episodes, S/P cholecystectomy, retinopathy, and severe AVN of the right hip in the second patient. Both patients were admitted frequently to the hospital due to severe acute painful episodes involving mostly the hips and lower extremities. In both patients, a Medtronic Indura Catheter was inserted intrathecally under fluoroscopy guidance. The entry level was at the L3–L4 lumbar space and the tip of the catheter reached the T8 level. The catheter was attached to an Isomed pump that was filled with a mixture of preservative free morphine and clonidine and placed in a subcutaneous pouch in the abdominal wall. The first patient required 0.5mg of morphine and 25mg of clonidine daily, and the second patient required 1.5mg of morphine and 150mg of clonidine daily. The pumps were refilled every 2–3 months. No side effects were noted and the vital signs of both patients remained stable. Both patients continue to use IMA for 2–3 years to date with no complications. The utilization of IMA resulted in significant decrease in the frequency of acute painful episodes treated in the emergency room or hospital, as well as the number of hospital days and the amount of oral opioid consumption expressed in morphine sulfate (MOSO4) equivalent as shown in the table. Moreover, the quality of life of both patients improved: the first patient resumed social and family activities and the second patient could be gainfully employed. The data show that utilization of IMA in selected patients with severe intractable pain below the diaphragm has a significant salutary effect on the frequency and duration of hospital admissions and the total amount of opioids consumed.Effect of IMA on Annual Utilization of Medical Facilities and Opioid ConsumptionHospital AmissionsHospital DaysER VisitsPO MOSO4 EquivalentPatient #1Before IMA152221417585 mgAfter IMA78876885 mgPatient #2Before IMA919218415 mgAfter IMA51893310 mg