Acute pain management in children with sickle cell anaemia during emergency admission to a teaching hospital in Lagos, Nigeria

Abstract

Background. Optimal pain management in children with sickle cell anaemia (SCA) begins with accurate and thorough pain assessment. However, little or no evidence of this practice exists among SCA patients in developing countries. 

Objectives. To evaluate pain management in children with SCA during emergency admission. 

Methods. Children with SCA who were ≤12 years old, on admission for a painful crisis and who were not using herbal remedies for pain relief, were prospectively studied at the Lagos University Teaching Hospital (LUTH) over a period of 1 year. A proforma data collection form was used to obtain information about the demographics of the patients and their parents, as well as pain score, and non-pharmacological and pharmacological treatments documented in the patients’ case files. Pain was assessed for each patient using the Wong-Bakers Faces Pain Rating Scale. 

Results. The median age and weight of the patients were 4 years and 16 kg, respectively. Pain assessment by the physicians was documented in 10 (8.3%) patients. However, among those assessed for pain by the researchers, 90 (75%) had a moderate pain score of 5 - 8. Fluid therapy (n=110, 91.7%) and prayers (n=120, 100%) were the most common non-pharmacological therapies administered to the patients while admitted. Analgesics, either in combinations or as a single medicine, were administered to 100 (83.3%) patients. Paracetamol (n=90, 75%) and pentazocine (n=80, 66.7%) were the most frequently used analgesics. The dosage of the analgesics prescribed did not conform to the recommendations of the World Health Organization (WHO). 

Conclusion. The SCA children in this study were managed sub-optimally with analgesics. Pain management among this group of children did not fully conform to the guidelines of the WHO.