Influence of choice of analgesic agent on the course and outcome of sickle cell patients presented to ICU with acute chest syndrome

Abstract

Background Sickle cell anemia is an inherited disease in which red blood cells become crescent shaped, resulting in abnormal function causing small blood clots that give rise to recurrent painful episodes called sickle cell pain crises. Acute chest syndrome (ACS) is the leading cause of death among patients with sickle cell disease. The purpose of the study was to compare tramadol versus dexmedetomidine as a painkiller and a morphine-sparing drug, besides its role in improvement of the respiratory parameters and improving prognosis in patients with ACS. Patients and methods Over a period of 1 year, this prospective study was conducted on 60 sickle cell disease patients admitted to the ICU with ACS. Patients were randomly allocated into two groups, each containing 30 patients. Group A (n = 30) received morphine (10–20 mcg/kg/h) + tramadol (0.2 mg/kg/h) intravenous infusion. Group B (n = 30) received morphine (10–20 mcg/kg/h) + dexmedetomidine (0.5 mcg/kg/h) intravenous infusion. The effi cacy of the study medications were compared in this study between the two groups in terms of pain relief assessment using a visual analogue scale. At the same time, the degree of sedation was monitored according to a four-point scale and bispectral index. Lung performance was assessed between the two groups through arterial blood gases, oxygenation index, and rapid shallow breathing index monitoring; hemodynamic parameters were also measured. All these variables were monitored for the fi rst 4 days of admission to the ICU. The outcome prognosis was also compared between the two groups in terms of the average length of ICU stay, and survival or death was assessed during a follow-up of as long as 20 days. Results Signifi cant difference was found with regard to pain relief among the study groups, with signifi cantly lower (visual analogue scale) parameters in group A (n = 30) (morphine/tramadol) compared with group B (n = 30) (morphine/dexmedetomidine). No signifi cant difference was discovered regarding degree of awareness, lung performance, and hemodynamic parameters among the two study groups. With regard to outcome prognosis, in terms of average length of ICU stay and mortality, comparable results were obtained in the two groups. Conclusion Adequate pain control is one of the cornerstones in the management of ACS; yet no infl uence on the outcome prognosis was detected in the choice of study medications