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2015 ; 15
(8
): E90-7
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English Wikipedia
Dexmedetomidine as an Adjuvant to Analgesic Strategy During Vaso-Occlusive
Episodes in Adolescents with Sickle-Cell Disease
#MMPMID26205912
Pain Pract
2015[Nov]; 15
(8
): E90-7
PMID26205912
show ga
Patients with sickle-cell disease (SCD) can experience recurrent vaso-occlusive
episodes (VOEs), which are associated with severe pain. While opioids are the
mainstay of analgesic therapy, in some patients with SCD, increasing opioid use
is associated with continued and increasing pain. Dexmedetomidine, an ?2
-adrenoreceptor agonist with sedative and analgesic properties, has been
increasingly used in the perioperative and intensive care settings and has been
shown to reduce opioid requirement and to facilitate opioid weaning. Therefore,
there might be a role for dexmedetomidine in pain management during VOEs in
patients with SCD. Here, we present the hospital course of 3 patients who during
the course of VOEs had severe pain unresponsive to opioids and ketamine and were
treated with dexmedetomidine. Dexmedetomidine infusions that lasted for 3 to
6 days were associated with marked reduction in daily oral morphine-equivalent
intake and decreases in pain scores (numeric rating scale). There were no
hemodynamic changes that required treatment with vasoactive or anticholinergic
agents. These preliminary findings of possible beneficial effects of
dexmedetomidine in decreasing opioid requirements support the hypothesis that
dexmedetomidine may have a role as a possible analgesic adjuvant to mitigate
VOE-associated pain in patients with SCD.