Opioid use in the treatment of pain in adult patients with VOC due to SCD
| Text . | Time to first dose . | Parenteral opioid . | Need to individualize . | Refer to guidelines . | |
|---|---|---|---|---|---|
| Dose . | Frequency . | ||||
| Guidelines | |||||
| APS2 /NIH4 | 15-20 min | 5-10 mg morphine or 1.5 mg hydromorphone | 15-30 min* | Yes | N/A |
| BCSH3 | <30 min | 0.1 mg/kg morphine | <20 min† | Yes | N/A |
| Hematology | |||||
| Wintrobe's9 | Not stated | Not stated | Not stated | Not stated | No |
| Hoffman10 | “Prompt” | Morphine 0.1-0.15 mg/kg | 20 min | Not stated | Yes |
| Williams11 | Not stated | Not stated | Not stated | Not stated | Yes |
| Handin et al12 | Not stated | Not stated | Not stated | Yes | No |
| Bethesda13 | Not stated | Not stated | Not stated | Yes | Yes (NIH) |
| Boyiadzis et al14 | Not stated | 5-10 mg morphine or 1.5 mg hydromorphone | 2-4 h‡ | No§ | Yes (both) |
| Young et al15 | “Rapid” | 5-10 mg morphine | 30 min∥ | Yes | Yes (NIH) |
| Hillman et al16 | Not stated | Not stated | Not stated | Not stated | No |
| Hoffbrand et al17 | Not stated | Not stated | Not stated | Yes | No |
| Emergency medicine | |||||
| Rosen's18 | Not stated | Morphine 0.15 mg/kg (up to 10 mg)¶ | Not stated | Not stated | No |
| Tintinalli19 | Not stated | Not stated | Not stated | Yes | No |
| Harwood-Nuss'20 | Not stated | Not stated | Not stated | Yes | No |
| Internal medicine | |||||
| Oxford21 | Not stated | Morphine 0.1 mg/kg# | 1 h | Not stated | No |
| Cecil22 | Not stated | Morphine 0.1 mg/kg (up to 10 mg) or hydromorphone 0.01-0.02 mg/kg | 3-4 h | Not stated | No |
| Washington Manual23 | Not stated | Morphine 0.1-0.2 mg/kg or hydromorphone 0.02-0.04 mg/kg** | 2-3 h** | Yes | Yes |
| ACP Medicine24 | “Rapid evaluation” | Morphine 10 mg or hydromorphone 4 mg | 30 min ×1†† | Not stated | No |
| Harrison's25 | Not stated | Morphine 0.1-0.15 mg/kg | 3-4 h | Not stated | No |
| Conn's26 | Not stated | Hydromorphone 2-4 mg‡‡ | 30-45 min‡‡ | Not stated | No |
| Up-to-date27 | Not stated | Morphine 2 mg infused over 4-5 min§§ | 1-3 h§§ | Not stated | Yes |
| Text . | Time to first dose . | Parenteral opioid . | Need to individualize . | Refer to guidelines . | |
|---|---|---|---|---|---|
| Dose . | Frequency . | ||||
| Guidelines | |||||
| APS2 /NIH4 | 15-20 min | 5-10 mg morphine or 1.5 mg hydromorphone | 15-30 min* | Yes | N/A |
| BCSH3 | <30 min | 0.1 mg/kg morphine | <20 min† | Yes | N/A |
| Hematology | |||||
| Wintrobe's9 | Not stated | Not stated | Not stated | Not stated | No |
| Hoffman10 | “Prompt” | Morphine 0.1-0.15 mg/kg | 20 min | Not stated | Yes |
| Williams11 | Not stated | Not stated | Not stated | Not stated | Yes |
| Handin et al12 | Not stated | Not stated | Not stated | Yes | No |
| Bethesda13 | Not stated | Not stated | Not stated | Yes | Yes (NIH) |
| Boyiadzis et al14 | Not stated | 5-10 mg morphine or 1.5 mg hydromorphone | 2-4 h‡ | No§ | Yes (both) |
| Young et al15 | “Rapid” | 5-10 mg morphine | 30 min∥ | Yes | Yes (NIH) |
| Hillman et al16 | Not stated | Not stated | Not stated | Not stated | No |
| Hoffbrand et al17 | Not stated | Not stated | Not stated | Yes | No |
| Emergency medicine | |||||
| Rosen's18 | Not stated | Morphine 0.15 mg/kg (up to 10 mg)¶ | Not stated | Not stated | No |
| Tintinalli19 | Not stated | Not stated | Not stated | Yes | No |
| Harwood-Nuss'20 | Not stated | Not stated | Not stated | Yes | No |
| Internal medicine | |||||
| Oxford21 | Not stated | Morphine 0.1 mg/kg# | 1 h | Not stated | No |
| Cecil22 | Not stated | Morphine 0.1 mg/kg (up to 10 mg) or hydromorphone 0.01-0.02 mg/kg | 3-4 h | Not stated | No |
| Washington Manual23 | Not stated | Morphine 0.1-0.2 mg/kg or hydromorphone 0.02-0.04 mg/kg** | 2-3 h** | Yes | Yes |
| ACP Medicine24 | “Rapid evaluation” | Morphine 10 mg or hydromorphone 4 mg | 30 min ×1†† | Not stated | No |
| Harrison's25 | Not stated | Morphine 0.1-0.15 mg/kg | 3-4 h | Not stated | No |
| Conn's26 | Not stated | Hydromorphone 2-4 mg‡‡ | 30-45 min‡‡ | Not stated | No |
| Up-to-date27 | Not stated | Morphine 2 mg infused over 4-5 min§§ | 1-3 h§§ | Not stated | Yes |
Doses are given for intravenous or subcutaneous administration.
APS indicates American Pain Society; NIH, National Institutes of Health; N/A, not applicable; and BCSH, British Committee on Standardization in Haematology.
Use 1/4 to 1/2 of initial dose for follow-up treatment.
Use the same dose as the initial dose for follow-up treatment.
Patient is assessed every 15 to 30 minutes but opioid doses indicated as every 2 to 4 hours.
Individualization suggested only for patients on chronic opioid therapy.
Use 2.5 to 5.0 mg morphine every 30 minutes until pain relieved.
Or morphine 5 mg bolus then 5 mg/h by PCA.
Or morphine infusion at 2 mg/min (maximum=10 mg) but further doses not specified, or diamorphone 0.05 mg/kg subcutaneously or intramuscularly.
Or morphine by PCA infusion at 2 mg/h plus 2- to 10-mg boluses every 6 to 10 minutes.
See “Textbook recommendations for opioid use for VOCs in SCD.”
Recommended for opioid-naive patients. For others, 4 to 8 mg hydromorphone can be infused over 15 to 20 minutes with a 4-mg dose repeated in 30 minutes.
Chapter on SCD refers to chapter on “Pain Control in the Intensive Care Unit” where these recommendations were obtained. Can increase morphine dose by 1 to 2 mg every 1 to 3 hours.