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Sickle Cell Pain Crisis In Adults: An Assessment Of The Management By Medical Practitioners In Nigeria
Abstract
Background: Sickle cell pain crisis is a common medical emergency in Nigeria. The treatment approach to this common problem is known to vary amongst medical practioners.
Subjects and Methods: A cross-sectional survey of one hundred and seventy-four medical practitioners was carried out using a questionnaire. They were interviewed concerning their mode of treatment of sickle cell pain crises. Information obtained included professional qualification and date, field of specialization, number and severity of pain crises attended to, choice of analgesics in pain crises, type and quantity of fluid, use of anti-malarial drugs and antibiotics in pain crises.
Results: Their experience ranged from 2 to 34 years. 65 (37.6%) were within 5 years and 108 (62.4%) would however not prescribe narcotic analgesics even in severe pain crises, for various reasons. As many as 38 of 174 ( 24.2%) would give inadequate quantity of fluid and 18 of 124 (14.6%) will not give antibiotics even in the presence of markedly elevated white blood cell count, 45 of 90 (50%) will give anti-malarial drugs routinely. Others will give anti-malarial drugs only if there is fever. None of the doctors will insist on a laboratory demonstration of malaria parasitaemia before giving anti-malaria drugs. There was no statistically significant difference in the management of pain crisis by doctors who were within 5 years when compared with those above 5 years post-qualification.
Conclusion: Although, 70-80% of the doctors manage pain crises appropriately, it would be desired that all doctors manage sickle cell pain crises properly. To achieve this, a pain management protocol may be introduced in order to ensure that every sickle cell pain crisis is appropriately and consistently managed.
Key Words: Sickle cell, pain, crisis, acute complications and management.
Nigerian Journal of Clinical Practice Vol.5(2) 2002: 109-114
Subjects and Methods: A cross-sectional survey of one hundred and seventy-four medical practitioners was carried out using a questionnaire. They were interviewed concerning their mode of treatment of sickle cell pain crises. Information obtained included professional qualification and date, field of specialization, number and severity of pain crises attended to, choice of analgesics in pain crises, type and quantity of fluid, use of anti-malarial drugs and antibiotics in pain crises.
Results: Their experience ranged from 2 to 34 years. 65 (37.6%) were within 5 years and 108 (62.4%) would however not prescribe narcotic analgesics even in severe pain crises, for various reasons. As many as 38 of 174 ( 24.2%) would give inadequate quantity of fluid and 18 of 124 (14.6%) will not give antibiotics even in the presence of markedly elevated white blood cell count, 45 of 90 (50%) will give anti-malarial drugs routinely. Others will give anti-malarial drugs only if there is fever. None of the doctors will insist on a laboratory demonstration of malaria parasitaemia before giving anti-malaria drugs. There was no statistically significant difference in the management of pain crisis by doctors who were within 5 years when compared with those above 5 years post-qualification.
Conclusion: Although, 70-80% of the doctors manage pain crises appropriately, it would be desired that all doctors manage sickle cell pain crises properly. To achieve this, a pain management protocol may be introduced in order to ensure that every sickle cell pain crisis is appropriately and consistently managed.
Key Words: Sickle cell, pain, crisis, acute complications and management.
Nigerian Journal of Clinical Practice Vol.5(2) 2002: 109-114
