2025 Southeastern Residency Conference

Title: Comparison of Patient-Controlled Analgesia (PCA) and non-PCA Opioid Pain Management Modalities in Sickle Cell Disease (SCD) During Vaso-Occlusive Crises (VOC)
 
Authors: Natalie Ortiz-Gratacos; Megan Durango; Nicholas Mastromarino; Irina Santamaria


Objective: To identify differences between treatment modalities for VOC in SCD. \


Self-Assessment: Based on this retrospective study, which modality had a lower morphine milliequivalent (MME) requirement?


Background: SCD causes acute pain episodes called VOC, often leading to hospitalization. The American Society of Hematology recommends intravenous (IV) opioids for VOC treatment, but the optimal administration method remains uncertain. Opioids can be given via PCA or intermittent bolus referred to as non-PCA. While some studies suggest PCAs reduce hospital stay and opioid use, others find non-PCA methods offer better pain control and shorter stays. The purpose of this study is to compare PCA versus non-PCA opioid modalities to identify the most efficient pain modality during VOC. 


Methods: Patients included in this study were 18 years or older with a preexisting SCD diagnosis, two or more admissions to AdventHealth Central Florida Division and who were treated with both modalities (PCA vs non-PCA) in separate encounters. The reason for admission had to be for pain from VOC. The primary objective is to evaluate the change in pain intensity scores for each modality. The secondary objectives are mean pain scores, length of stay (LOS), 30-day readmission rates, leaving against medical advice (AMA) rates, daily average MMEs, and life-threatening opioid side effects (naloxone use). 


Results: Sixteen patients participated in this study. A within-patient comparison was conducted between two encounters; one with PCA and one without PCA for each patient. Ten patients reported lower pain scores during the PCA encounter, while six patients reported lower pain scores during the non-PCA encounter. In terms of percentage differences in pain scores, eight patients experienced a greater reduction with PCA, five with non-PCA, and three had no difference. Although there were differences among the groups, none were found to be statistically significant. The average percent reduction between the initial and final pain scores was higher in the PCA group compared to the non-PCA group (49% vs 43%, respectively, p= 0.416). The mean pain score for the PCA encounters was not significantly lower than for non-PCA encounters (6.67±2.60 vs 6.82±2.51, p=0.717). Regarding LOS and daily average MMEs, the non-PCA group had lower values of 5.6 days and 169 MMEs compared to the PCA group of 7 days and 210 MMEs, (p= 0.23 and 0.599, respectively). However, 30-day readmission rates were lower in the PCA group (7 patients) than in the non-PCA group (9 patients); p=0.687. AMA rates were the same between the groups (p= 1). No naloxone was used in the non-PCA group, while one patient in the PCA group required naloxone (p=1). 


Conclusion: The treatment of VOC in SCD patients using a PCA may be associated with greater pain reduction at discharge and readmission rates compared to non-PCA modalities. However, the PCA group also exhibited higher MME amounts and one incidence of naloxone use. From the within patient comparison, it was concluded the majority of patients had better pain control with PCA use. Further studies are needed to support these findings.