Fentanyl Buccal Tablet: A New Breakthrough Pain Medication in Early Management of Severe Vaso‐Occlusive Crisis in Sickle Cell Disease

Franceschi, Lucia De; Mura, Paolo; Schweiger, Vittorio; Vencato, Elisa; Quaglia, Francesca Maria; Delmonte, L; Evangelista, Maurizio; Polati, Enrico; Olivieri, Oliviero; Finco, Gabriele

doi:10.1111/papr.12313

Cited by 14 publications

(11 citation statements)

References 35 publications

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“…However, MDCT or MRI, whenever MDCT is contraindicated, should also be considered in SCD patients with severe clinical presentation with persistent abdominal pain in the absence of evidence for bilio‐pancreatic tract or liver or kidney disease. Furthermore, MDCT or MRI are required to achieve a thorough characterization of PVT after US‐Doppler PVT identification …”

Section: Discussionmentioning

confidence: 99%

“…At the admission in the ED, patient VAS pain‐score was 7. Multimodal analgesia with tramadol (7.2 mg/kg/d), ketorolac (0.86 mg/kg/d) and metoclopramide associated with intravenous hydration (saline solution 20‐30 mL/kg/d) and ceftriaxone (2 g/d) was started . Abdominal ultrasound (US) was negative and portal vein velocity was normal at the admission to the ED and at 48 hours after hospitalization.…”

Section: Most Common and Unusual Causes Of Right Upper Quadrant Pain mentioning

confidence: 99%

“…Since PV recanalization generally occurs up to 6 months after starting AC, a follow‐up imaging study after 6 months of AC is recommended . The imaging follow‐up might be carried out by either MDCT or MRI or CDUS whenever technically feasible . At 4 months control, our patient was switched from LMWH to rivaroxaban, starting with 15 mg twice a day for 3 weeks, then 20 mg/day up‐to the 6 months control.…”

Section: Most Common and Unusual Causes Of Right Upper Quadrant Pain mentioning

confidence: 99%

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Persistent abdominal pain related to portal vein thrombosis in young adult with sickle cell disease

et al. 2018

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A 35-year-old man with sickle cell disease (SCD, S/β 0 ) was admitted to our emergency department (ED) for right upper quadrant abdominal pain (RUQ) associated with fever (38 C) and jaundice (Charcot's triad; Total Bil. 3.19 mg/dL). Pain was constantly midepigastric, often radiated to the back. Laboratory tests showed increased CRP (93 mg/dL), ALT (71 U/L), and LDH (347 U/L); whereas, AST (32 U/ L), γGT (19 U/L), albumin (34.1 g/L), total protein (74.1 g/L), amylase, aPTT, PT were within normal range. CBC documented Hb 8.7 g/dL, circulating erythroblasts 510.000/mm 3 , WBC 11 800/mm 3 , PLTs 286 000/ mm 3 . The collection of patient history revealed: splenectomy at the age of 8 years and cholecistectomy at age of 19 years.He was taking hydroxyurea (20 mg/kg/d) therapy since the age of 17 years due to recurrent pain crisis, requiring hospitalization, and aspirin (100 mg/d) since splenectomy. Two previous episodes of superficial venous thrombosis were reported by the patient.RUQ pain occurs in almost 10% of SCD patients during acute vaso-occlusive crisis (VOC) and it is one of the first three causes of access to the ED admission. 1 RUQ pain is generally associated with increased AST/ALT ratio, which rapidly decreases at resolution of the VOC. Although RUQ pain is generally related to VOCs, a wide variety of conditions has been recognized to possibly sustain abdominal pain and jaundice in SCD (Table 1). 1-3 However, emergency physician rarely considers other causes of RUQ pain than VOC in SCD subjects (see also Table 1). This might expose SCD patients to the risk of undertreatment or misdiagnosis of RUQ pain and possibly mismanagement. Thus, it is mandatory to discriminate with the patient whether the abdominal pain episode has characteristics similar to previous once experienced by the patients in order to consider causes others than VOCs and to decide a more aggressive diagnostic approach. 4At the admission in the ED, patient VAS pain-score was 7. Multimodal analgesia with tramadol (7.2 mg/kg/d), ketorolac (0.86 mg/ kg/d) and metoclopramide associated with intravenous hydration (saline solution 20-30 mL/kg/d) and ceftriaxone (2 g/d) was started. 5,6 Abdominal ultrasound (US) was negative and portal vein velocity was normal at the admission to the ED and at 48 hours after hospitalization.Abdominal-US is generally used to exclude biliary obstruction and/or dilation (intrahepatic, extrahepatic, or both) or to document primary liver disorders, such as infections/abscesses or portal vein disease as well as pancreatic diseases such as acute or chronic pancreatitis or gallstone-related pancreatic disease. However, US does not allow the identification of choledocholithiasis, which requires MR cholangiopancreatography (MRCP). Multidetector Computed Tomography (MDCT) is, overall, the gold standard imaging approach for undifferentiated abdominal pain, especially in presence of fever and nonlocalized symptoms. MDCT can also better delineate complicated biliary disorders, such as gas-forming processes, abscesses, hemorrhage, ...

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Section: Discussionmentioning

confidence: 99%

Section: Most Common and Unusual Causes Of Right Upper Quadrant Pain mentioning

confidence: 99%

Section: Most Common and Unusual Causes Of Right Upper Quadrant Pain mentioning

confidence: 99%

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Persistent abdominal pain related to portal vein thrombosis in young adult with sickle cell disease

et al. 2018

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“…Complete blood count, HbS levels, biochemical tests, standard urine analysis, and proteinuria were determined at each visit site. Painful VOCs, defined as bone pain (i.e., extremities, hips, or back) or abdominal pain, for which no other clinical explanation was identified, was described with a visual analog scale (VAS) pain level of 7 or more as severe VOC, pain VAS of 5 to 7 as mild VOC, and pain VAS 3 to 5 as moderate VOC . Each hospitalization was defined as an episode of VOC as previously reported .…”

Section: Methodsmentioning

confidence: 99%

“…Painful VOCs, defined as bone pain (i.e., extremities, hips, or back) or abdominal pain, for which no other clinical explanation was identified, was described with a visual analog scale (VAS) pain level of 7 or more as severe VOC, pain VAS of 5 to 7 as mild VOC, and pain VAS 3 to 5 as moderate VOC . Each hospitalization was defined as an episode of VOC as previously reported . Since a prothrombotic state of sickle cell patients has been reported, and being SCD is a recognized independent risk factor for venous thromboembolic events during pregnancy, enoxaparin was introduced at the prophylactic dosage of 4000 U daily at the first visit site after a positive pregnancy test.…”

Section: Methodsmentioning

confidence: 99%

Improvement of maternal and fetal outcomes in women with sickle cell disease treated with early prophylactic erythrocytapheresis

Vianello

Vencato

Cantini³

et al. 2018

Transfusion

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Pharmacological interventions for painful sickle cell vaso-occlusive crises in adults

Cooper

Hambleton

Ballas

et al. 2019

Cochrane Database of Systematic Reviews

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Fentanyl Buccal Tablet: A New Breakthrough Pain Medication in Early Management of Severe Vaso‐Occlusive Crisis in Sickle Cell Disease

Cited by 14 publications

References 35 publications

Persistent abdominal pain related to portal vein thrombosis in young adult with sickle cell disease

Persistent abdominal pain related to portal vein thrombosis in young adult with sickle cell disease

Improvement of maternal and fetal outcomes in women with sickle cell disease treated with early prophylactic erythrocytapheresis

Pharmacological interventions for painful sickle cell vaso-occlusive crises in adults

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