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dc.contributor.authorTelfer, Paul
dc.contributor.authorBestwick, Jonathan
dc.contributor.authorElander, James
dc.contributor.authorOsias, Arlene
dc.contributor.authorKhalid, Nosheen
dc.contributor.authorSkene, Imogen
dc.contributor.authorNzouakou, Ruben
dc.contributor.authorChallands, Joanne
dc.contributor.authorBarroso, Filipa
dc.contributor.authorKaya, Banu
dc.date.accessioned2021-08-10T07:53:00Z
dc.date.available2021-08-10T07:53:00Z
dc.date.issued2021-08-02
dc.identifier.citationTelfer, P., Bestwick, J., Elander, J., Osias, A., Khalid, N., Skene, I., Nzouakou, R., Challands, J., Barroso, F., & Banu, K. (2021). 'A non-injected opioid analgesia protocol for acute pain crisis in adolescents and adults with sickle cell disease'. British Journal of Pain, pp. 1-12.en_US
dc.identifier.doi10.1177/20494637211033814
dc.identifier.urihttp://hdl.handle.net/10545/625922
dc.description.abstractInitial management of the acute pain crisis (APC) of sickle cell disease (SCD) is often unsatisfactory, and might be improved by developing a standardised analgesia protocol. Here, we report the first stages in developing a standard oral protocol for adolescents and adults. Initially, we performed a dose finding study to determine the maximal tolerated dose of sublingual fentanyl (MTD SLF) given on arrival in the acute care facility, when combined with repeated doses of oral oxycodone. We used a dose escalation algorithm with two dosing ranges based on patient’s weight (<50 kg or >50 kg). We also made a preliminary evaluation of the safety and efficacy of the protocol. The study took place in a large tertiary centre in London, UK. Ninety patients in the age range 14–60 years were pre-consented and 31 treatment episodes were evaluated. The first 21 episodes constituted the dose escalation study, establishing the MTD SLF at 600 mcg (>50 kg) or 400 mcg (<50 kg). Further evaluation of the protocol indicated no evidence of severe opioid toxicity, nor increased incidence of acute chest syndrome (ACS). Between 0 and 6 hours, the overall gradient of reduction of visual analogue pain score (visual analogue scale (VAS)) was 0.32 centimetres (cm) per hour (95% confidence interval (CI) = 0.20 to 0.44, p < 0.001). For episodes on MTD SLF, there was median (interquartile range (IQR)) reduction in VAS score of 2.8 cm (0–4.2) and 59% had at least a 2.6-cm reduction. These results are supportive of further evaluation of this protocol for acute analgesia of APC in a hospital setting and potentially for supervised home management.en_US
dc.description.sponsorshipThe trial was funded by a grant from the Barts Charity (reference no. 1704), the National Institute for Health Research North Thames Clinical Research Network Divisional Contingency Funding, and unrestricted grants from Kyowa Kirin and Napp Pharmaceuticals.en_US
dc.language.isoenen_US
dc.publisherSageen_US
dc.relation.urlhttps://journals.sagepub.com/doi/10.1177/20494637211033814en_US
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International*
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/*
dc.subjectSickleen_US
dc.subjectCrisisen_US
dc.subjectPainen_US
dc.subjectOpioiden_US
dc.subjectVOCen_US
dc.subjectAnalgesiaen_US
dc.titleA non-injected opioid analgesia protocol for acute pain crisis in adolescents and adults with sickle cell diseaseen_US
dc.typeArticleen_US
dc.identifier.eissn2049-4645
dc.contributor.departmentUniversity of Derbyen_US
dc.identifier.journalBritish Journal of Painen_US
dcterms.dateAccepted2021-06-25
refterms.dateFOA2021-08-10T07:53:01Z
dc.author.detail779740en_US


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