PMID- 23527666
OWN - NLM
STAT- MEDLINE
DCOM- 20140421
LR  - 20130326
IS  - 1536-0539 (Electronic)
IS  - 1536-0288 (Linking)
VI  - 27
IP  - 1
DP  - 2013 Mar
TI  - Pilot study of human recombinant hyaluronidase-enhanced subcutaneous hydration 
      and opioid administration for sickle cell disease acute pain episodes.
PG  - 10-8
LID - 10.3109/15360288.2012.758683 [doi]
AB  - The objective of this study was to determine the feasibility of protocol-driven 
      human recombinant hyaluronidase (rHuPH20)-enhanced subcutaneous (SC) hydration 
      and opioid administration in adults presenting to the emergency department (ED) 
      with sickle cell disease acute pain episodes (SCDAPE). Adults with SCDAPE were 
      given 150 U of rHuPH20 and normal saline subcutaneously. Opioids were 
      administered SC every 15 minutes for 4 hours until numerical rating scale (NRS) 
      pain intensity scores fell to <5, or Ramsay Sedation Scores were >4. Pain 
      intensity and pain relief were recorded hourly. Total morphine equivalents and 
      fluid volume, total pain relief (TOTPAR), patient- and physician-perceived global 
      efficacy, patient-perceived global SC needle discomfort, physician-rated ease of 
      needle placement, and adverse effects were noted. Ten patients (6 males, 4 
      females), mean age 32.9 years (23-56 years) completed the trial. Mean pain 
      intensity scores fell 25% (from 9.2 to 6.9) from baseline and mean 4-hour TOTPAR 
      score was 4 (maximum: 16). A mean total of 119 mg (70-170 mg) morphine 
      equivalents and 846 mL (200-1650 mL) normal saline were administered. Mean 
      patient and physician global perceived efficacy ratings were 3.4 and 4.2 (of 5). 
      Patient global discomfort of SC needle presence was 2.7 (of 10), and ease of 
      needle placement was physician rated at 4 (of 4; easiest). Patients experienced 
      mild swelling and stinging at the SC site, and no infusion required 
      discontinuation. The authors conclude that rHuPH20-enhanced subcutaneous 
      hydration and opioid administration appear feasible from this pilot study. These 
      results need confirmation in a controlled clinical trial.
FAU - Sandoval, Marcelo
AU  - Sandoval M
AD  - Department of Emergency Medicine, MD Anderson Cancer Center, Houston, Texas, USA. 
      msandoval@mdsanderson.org
FAU - Coleman, Patricia
AU  - Coleman P
FAU - Govani, Rahim
AU  - Govani R
FAU - Siddiqui, Saima
AU  - Siddiqui S
FAU - Todd, Knox H
AU  - Todd KH
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - J Pain Palliat Care Pharmacother
JT  - Journal of pain & palliative care pharmacotherapy
JID - 101125608
RN  - 0 (Analgesics, Opioid)
RN  - 0 (Recombinant Proteins)
RN  - 76I7G6D29C (Morphine)
RN  - EC 3.2.1.35 (Hyaluronoglucosaminidase)
RN  - Q812464R06 (Hydromorphone)
SB  - IM
MH  - Acute Pain/*complications/*drug therapy/*therapy
MH  - Adult
MH  - Analgesics, Opioid/administration & dosage/therapeutic use
MH  - Anemia, Sickle Cell/*complications
MH  - Combined Modality Therapy/methods
MH  - Female
MH  - Humans
MH  - Hyaluronoglucosaminidase/administration & dosage/*therapeutic use
MH  - Hydromorphone/administration & dosage/*therapeutic use
MH  - Hypodermoclysis/*methods
MH  - Injections, Subcutaneous
MH  - Male
MH  - Middle Aged
MH  - Morphine/administration & dosage/*therapeutic use
MH  - Pain Measurement/drug effects
MH  - Patient Satisfaction
MH  - Pilot Projects
MH  - Recombinant Proteins/administration & dosage/therapeutic use
EDAT- 2013/03/27 06:00
MHDA- 2014/04/22 06:00
CRDT- 2013/03/27 06:00
PHST- 2013/03/27 06:00 [entrez]
PHST- 2013/03/27 06:00 [pubmed]
PHST- 2014/04/22 06:00 [medline]
AID - 10.3109/15360288.2012.758683 [doi]
PST - ppublish
SO  - J Pain Palliat Care Pharmacother. 2013 Mar;27(1):10-8. doi: 
      10.3109/15360288.2012.758683.