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Analgesic Management of Uncomplicated Acute Sickle Cell Pain Crisis in Pediatric: A Systematic Review and Meta-Analysis
26 Pages Posted: 6 Dec 2018
More...Abstract
Background: Despite the in-depth understanding of acute sickle-cell pain, relieving it, well remained a challenge. However different drugs whose goal is played to analgesic role needed to elucidate. We therefore revised the efficacy and safety of those pharmaceuticals founded on the implementation of a systematic review and meta-analysis.
Methods: Key evidence of searches for this systematic review and meta-analysis of randomized, placebo-controlled trials of pharmacological analgesic interventions to manage the uncomplicated of acute sickle-cell pain in paediatric were performed from inception to March 31, 2018. The search strategies were fulfilled in ten scientific databases, involving PubMed, MEDLINE, Embase, and Clinicaltrials.gov. We excluded non-randomized controlled studies. The primary endpoint was to appraisal change in ladder pain score, hospital length-of-stay, and narcotics cumulative used. We extracted data from qualified trials. The estimates pooled were analyzed using inverse variance considered with random-effects models when moderate heterogeneity existed. Bias was evaluated on the Cochrane risk of bias tool.
Findings: We identified 692 studies, 4 randomized placebo-controlled trials were deemed for inclusion criteria (intranasal fentanyl, intravenous magnesium, arginine, and inhaled nitric oxide) including 227 patients. Founded on the grading of recommendations assessment, development, and evaluation (GRADE), quality evidences were ranged from low to moderate for each outcome. Meta-analysis of changes in ladder of pain score (standardized mean difference [SMD] 0·08 [95% CI 0·53‒0·37]; p=0.72; I2=61%,), length-of-stay in hospital (mean difference [MD] 5·05 hours [26·64‒16·55]; p=0·65; I2=0%,), and amount of narcotics used during the study (SMD 0·25 [0·55‒0·05]; p=0·10; I2=35%) showed non-statistically difference between two groups. The adverse events reported that more participants underwent pain at the drug delivery site in studies using intranasal fentanyl and intravenous magnesium and significant.
Interpretation: Given respect to clinical advantage, no decisive deduction may be undertaken regarding to these medications in acute sickle-cell pain managing.
Funding Statement: This work was supported by a grant from the Chinese National Natural Science Fund 81170005 and 81670007.
Declaration of Interests: The authors declare no competing interests.
Suggested Citation: Suggested Citation