Skip to main content
SpringerLink
Log in

Intravenous Acetaminophen vs Intravenous Diclofenac Sodium in Management of Skeletal Vaso-occlusive Crisis Among Children with Homozygous Sickle Cell Disease: A Randomized Controlled Trial

  • Research Paper
  • Published:
Indian Pediatrics Aims and scope Submit manuscript

Abstract

Objective

To compare the efficacy of intravenous acetaminophen and intravenous diclofenac sodium in the management of skeletal vaso-occlusive crisis among children with sickle cell disease.

Design

Single blind randomized controlled trial.

Setting

Tertiary care hospital.

Participants

104 children with sickle cell disease and skeletal vaso-occlusive crisis.

Intervention

Intravenous acetaminophen at 10mg/kg/dose 8 hourly and intravenous diclofenac sodium at 1mg/kg/dose 8 hourly in 1:1 ratio.

Main outcome measures

Reduction in pain score (50%), number of doses needed to relieve pain after 24 hours of drug administration and decrease in pain score at 1 hour.

Results

A 50% reduction in pain score was seen in 35 (77.3%) and 10 (21.7%) children among acetaminophen and diclofenac sodium groups respectively (RR, 95% CI 3.6; 2.02–6.33, P< 0.001). The mean (SD) fall in pain score at 1 hour was significantly higher among intervention arm as compared to control arm [1.51 (0.5) and 1.06 (0.5); P<0.001]. Eight (17.4%) patients developed local phlebitis at the site of infusion among diclofenac group.

Conclusion

Intravenous acetaminophen is a better alternative to intravenous diclofenac in children with skeletal vaso-occlusive crisis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. De Franceschi L, Corrocher R. Established and experimental treatments for sickle cell disease. Haematologica. 2004;89:348–56.

    CAS  PubMed  Google Scholar 

  2. De Franceschi L, Cappellini MD, Olivieri O. Thrombosis and sickle cell disease. Semin Thromb Hemost. 2011;37:226–36.

    Article  CAS  Google Scholar 

  3. Uwaezuoke SN, Ayuk AC, Ndu IK, et al. Vaso-occlusive crisis in sickle cell disease: Current paradigm on pain management. J Pain Res. 2018:11:3141–50.

    Article  CAS  Google Scholar 

  4. Rees DC, Olujohungbe AD, Parker NE, et al. Guidelines for the Management of the Acute Painful Crisis in Sickle Cell Disease. Br J Haematol. 2003;120:744–52.

    Article  Google Scholar 

  5. Okpala I, Tawil A. Management of pain in sickle-cell disease. J R Soc Med. 2002;95:456–58.

    Article  Google Scholar 

  6. Stinson J, Naser B. Pain management in children with sickle cell disease. Pediatr Drugs. 2003;5:229–41.

    Article  Google Scholar 

  7. National Institute of Health and Care Excellence (NICE). Guidance — sickle cell acute painful episode. Accessed February 28, 2020. Available from: http://www.nice.org.uk/

  8. Gopinath R. Suggesting the value of diluted Diclofenac infused over a longer period of time as a method for reducing venous sequelae of IV diclofenac. Br J Anaesth. 1991;67:803.

    Article  CAS  Google Scholar 

  9. Strumer T, Erb A, Keller F, Gunther KP, Brenner H. Determinants of impaired renal functions with non-steroidal antiinflammatory drugs. Am J Med. 2001;111:521–7.

    Article  Google Scholar 

  10. Shastri N. Intravenous acetaminophen use in pediatrics. Pediatr Emerg Care. 2015;31:444–50.

    Article  Google Scholar 

  11. Dampier CD, Setty BN, Logan J, Ioli JG, Dean R. Intravenous morphine pharmacokinetics in pediatric patients with sickle cell disease. J Pediatr. 1995;126:461–7.

    Article  CAS  Google Scholar 

  12. Jahr JS, Lee VK. IV Acetaminophen. Anaesthesiol Clin. 2010;28:619–45.

    Article  CAS  Google Scholar 

  13. Jacob E, Miaskowski C, Savedra M, et al. Management of vaso-occlusive pain in children with sickle cell disease. J Pediatr Hematol Oncol. 2003;25:307–11.

    Article  Google Scholar 

  14. Baichoo P, Asuncion A, El-Chaar G. Intravenous acetaminophen for the management of pain during vasoocclusive crises in pediatric patients. PT. 2019;44:5–8.

    Google Scholar 

  15. Ceelie I, de Wildt SN, van Dijk M, et al. Effect of intravenous paracetamol on postoperative morphine requirements in neonates and infants undergoing major noncardiac surgery: A randomized controlled trial. JAMA. 2013;309:149–54.

    Article  CAS  Google Scholar 

  16. Lee CKK, Engorn B, Drug dosages. In: Engorn B, Flerlage J, editor. The Harriet Lane Hand Book: A manual for pediatric house officers, 20thed. Elsevier; 2015.p.667-8.

  17. Standing JF, Savage I, Pritchard D, Waddington M. Diclofenac for Acute pain in children. Cochrane Database Syst Rev. 2009;4:CD005538.

    Google Scholar 

  18. Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: A behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997;23:293–7.

    CAS  PubMed  Google Scholar 

  19. Wong DL, Baker CM. Pain in children: comparison of assessment scales. Pediatr Nurs. 1988;14:9–17.

    CAS  PubMed  Google Scholar 

  20. Shields BJ, Cohen DM, Harbeck-Weber C, et al. Pediatric pain measurement using a visual analogue scale: A comparison of two teaching methods. Clin Pediatr (Phila). 2003;42:227–34.

    Article  Google Scholar 

  21. Cooper TE, Hambleton IR, Ballas SK, Wiffen PJ. Pharmacological interventions for painful sickle cell vaso-occlusive crises in adults. Cochrane Database. Syst Rev. 2016, CD012187.

  22. Varrassi G, Marinangeli F, Agro FA, et al. A double-blinded evaluation of propacetamol versus ketorolac in combination with patient-controlled analgesia morphine: Analgesic efficacy and tolerability after gynecologic surgery. Anesth Analg. 1999;88:611–16.

    Article  CAS  Google Scholar 

  23. Paul D, Mathews J, Kulkarni SN. Comparative evaluation of efficacy of intravenous paracetamol and intravenous diclofenac as post-operative analgesia in laparoscopic cholecystectomy. International J Biomedical Res. 2015;6:482–87.

    Article  CAS  Google Scholar 

  24. Shaffer EE, Pham A, Woldman RL, et al. Estimating the effect of intravenous acetaminophen for postoperative pain management on length of stay and inpatient hospital costs. Adv Ther. 2016;33:2211–28.

    Article  Google Scholar 

  25. Sinatra RS, Jahr JS, Reynolds LW, et al. Efficacy and safety of single and repeated administration of 1 gram intravenous acetaminophen injection (paracetamol) for pain management after major orthopedic surgery. Anesthesiology. 2005;102:822–31.

    Article  CAS  Google Scholar 

  26. Tariq Haider S, Anwar A, Sultan T. Effectiveness and safety of Intravenous water based diclofenac sodium for post-operative pain management. Anaesthesia, Pain and Intensive Care. 2000;4:27–30.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, VSSIMSAR, Burla, Sambalpur, Odisha, India

    Prakash Chandra Panda, Nihar Ranjan Mishra, Chandra Sekhar Patra & Bijan Kumar Nayak

  2. Department of Community Medicine, VSSIMSAR, Burla, Sambalpur, Odisha, India

    Smita Kumari Panda

Authors
  1. Prakash Chandra Panda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nihar Ranjan Mishra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chandra Sekhar Patra
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bijan Kumar Nayak
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Smita Kumari Panda
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nihar Ranjan Mishra.

Additional information

Ethics approval

Veer Surendra Sai Institutional Research and Ethics Committee (VIREC); No: 2015/P-I-RP/128, dated 15 November, 2015.

Contributors

PCP: conceptualization and critical inputs to manuscript writing; NRM: data collection and writing the manuscript; NRM, CP and BKN: data collection, analysis and critical inputs to manuscript writing; SKP: supervision of the work and revision of manuscript.

Funding

None

Competing interests

None stated.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Panda, P.C., Mishra, N.R., Patra, C.S. et al. Intravenous Acetaminophen vs Intravenous Diclofenac Sodium in Management of Skeletal Vaso-occlusive Crisis Among Children with Homozygous Sickle Cell Disease: A Randomized Controlled Trial. Indian Pediatr 58, 229–232 (2021). https://doi.org/10.1007/s13312-021-2160-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13312-021-2160-3

Keywords

Search

Navigation