Pain management of children with sickle cell disease in the emergency department: recommendations and current situation in the French-Speaking Mother and Child Network

Abstract

Sickle cell disease is common in France, and painful episodes related to it are one of the main causes of emergency department visits. Management of acute painful episodes in children with sickle cell disease should follow the French National guidelines published by the High Authority of Health and updated in January 2010. For optimal pain management, it is important to quickly identify patients with sickle cell disease and assess their pain using validated scales. Pain can be treated using level 1 (paracetamol, ibuprofen) or level 2 analgesics (codeine, nalbuphine), and morphine in case of severe pain. Morphine can be administered using a patient-controlled analgesia (PCA) pump. Laboratory tests including complete blood count and reticulocyte count are often necessary. Adequate hydration and prevention of side-effects of opioids is also necessary. Sickle cell disease is a condition characterized by the occurrence of severe complications such as stroke, acute chest syndrome, severe bacterial infection and acute anaemia, thus requiring careful patient monitoring. Patients with sickle cell disease should be referred to specialized centres. A survey of practices conducted in the Réseau Mère-Enfant de la francophonie (RMEF) shows that pain assessment scales are widely used in patients with sickle cell disease and that morphine is the treatment of choice in cases of severe pain; however, the use of the PCA pumps for morphine administration is still not a common practice in the RMEF centres