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Randomized Controlled Trial
. 2010 Dec;40(6):870-82.
doi: 10.1016/j.jpainsymman.2010.03.020.

Hydroxyurea and acute painful crises in sickle cell anemia: effects on hospital length of stay and opioid utilization during hospitalization, outpatient acute care contacts, and at home

Samir K Ballas  1 , Robert L Bauserman, William F McCarthy, Oswaldo L Castro, Wally R Smith, Myron A Waclawiw; Investigators of the Multicenter Study of Hydroxyurea in Sickle Cell Anemia
Affiliations
Randomized Controlled Trial

Hydroxyurea and acute painful crises in sickle cell anemia: effects on hospital length of stay and opioid utilization during hospitalization, outpatient acute care contacts, and at home

Samir K Ballas et al. J Pain Symptom Manage. 2010 Dec.

Abstract

Context: Exploratory findings from the randomized, double-blind, placebo-controlled, multicenter study of hydroxyurea (MSH) in sickle cell anemia (SS). Recurrent acute painful crises may be mild, moderate, or severe in nature and often require treatment at home, in acute care facilities as outpatients, and in the hospital with oral and/or parenteral opioids.

Objectives: The objectives of this study were to determine the effects of hydroxyurea (HU) on length of stay (LOS) in hospital and opioid utilization during hospitalization, outpatient acute care contacts, and at home.

Methods: Data from patient diaries, follow-up visit forms, and medical contact forms for the 299 patients enrolled in the MSH were analyzed. Types and dosages of at home, acute care, and in-hospital analgesic usage were explored descriptively.

Results: At-home analgesics were used on 40% of diary days and 80% of two-week follow-up periods, with oxycodone and codeine the most frequently used. Responders to HU used analgesics on fewer days. During hospitalization, 96% were treated with parenteral opioids, with meperidine the most frequently used; oxycodone was the most commonly used oral medication. The average LOS for responders to HU was about two days less than for other groups, and their cumulative time hospitalized during the trial was significantly less than for nonresponders or placebo groups (P<0.022). They also had the lowest doses of parenteral opioids during acute care crises (P=0.015).

Conclusion: Beneficial effects of HU include shortening the duration of hospitalization because of acute painful episodes and reducing the net amount of opioid utilization.

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Figures

Figure 1
Figure 1
Utilization of oral opioids at home.
Figure 2
Figure 2
Utilization of each parenteral opioid by crisis location. The mean daily dose of each opioid (prior to equianalgesic transformation) is shown for inpatient crises only
See this image and copyright information in PMC

References

    1. Ballas SK. Pain management of sickle cell disease. Hematol Oncol Clin North Am. 2005;19(5):785–802. - PubMed
    1. Benjamin LJ. Nature and treatment of the acute painful episode in sickle cell disease. In: Steinberg MH, Forget BG, Higgs DR, Weatherall DJ, editors. Disorders of hemoglobin: Genetics, pathophysiology, and clinical management. New York: Cambridge University Press; 2001. pp. 671–710.
    1. Ballas SK. Current issues in sickle cell pain and its management. Hematology: American Society of Hematology Education Program Book. 2007. pp. 97–105. Available from: http://asheducationbook.hematologylibrary.org/cgi/content/full/2007/1/97. - PubMed
    1. Ballas SK. Sickle cell anemia. PIER Module of the American College of Physicians. [Last updated June 2009]. Available from: http://pier.acponline.org.
    1. Benjamin LJ, Payne R. Pain in sickle cell disease: a multidimensional construct. In: Pace B, editor. Renaissance of sickle cell disease research in the genomic era. London: Imperial College Press; 2007. pp. 99–118.

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