| Consider causes of pain other than VOE. |
| Conduct a thorough assessment of pain, including patient’s recent analgesic use (opioid and non-opiod) as well as patient’s knowledge of what agents have been successful in the past. |
| Initiate analgesic therapy within 30 minutes of triage or 60 minutes of registration (emergency department management). |
| Use an individualized prescribing and monitoring protocol, or SCD specific protocol to promote rapid, effective and safe analgesic management and resolution of VOE. |
| Treat with non-steroidal anti-inflammatory agents (NSAIDS) for persons with mild to moderate pain who report relief with NSAIDS, in the absence of contraindications. |
| For severe pain, rapidly initiate parenteral opioids. Calculate the parenteral opioid dose based on daily short acting opioids. |
| Administer opioids using the subcutaneous route when intravenous access is difficult. |
| Re-assess and re-administer opioids for continued severe pain every 15-30 minutes until pain is under control per patient report. |
| Initiate around the clock opioids by patient controlled analgesia (PCA) or frequently scheduled doses vs. “prn”. |
| Do not use meperidine unless it is the only effective opioid for an individual patient. |
| For patients that require antihistamine for itching caused by opioid administration, prescribe orally. Re-administer ever 4-6 hours if needed. |
| Encourage the use of the incentive spirometer to prevent acute chest syndrome in hospitalized adults and children. |
| In euvolemic patients who are unable to drink fluids, administer intravenous hydration at no more than maintenance rate to avoid over-hydration. |
| Use an objective sedation scale to monitor for excessive sedation. |
| Gradually titrate down parenteral opioids as VOE resolves. |
| Do not administer blood for the treatment of VOE. |
| Administer oxygen for patients with an oxygen saturation <95% on room air. |
| Encourage use of non-pharmacologic approaches to manage pain including heat and distraction. |
Citation: National Heart, Lung, and Blood Institute. (2014). Evidence-Based Management of Sickle Cell Disease: Expert Panel Report, 2014. Retrieved from https://www.nhlbi.nih.gov/sites/www.nhlbi.nih.gov/files/sickle-cell-disease-report.pdf