Table 2Summary GRADE table for pharmacological management of the underlying sickling process: isoxsuprine compared with pethidine (meperidine)

Number of studiesTreatmentPlaceboMeasure of effectQualityImportance
Pain rating up to 24 hours (assessed with: Visual Analogue Scale [VAS], 0–10, with 0 indicating no pain) in adults
1 (Al-Jama et al. 1999)isoxsuprinepethidineMean change from baseline −5 in both isoxsuprine and meperidine groups (from 10 at baseline in both groups)
MD* (30 minutes) = 2.00 (CI 0.82, 3.18)
MD (1 hour) = 1.60 (CI 0.25, 2.95)
MD (2 hours) = 0.70 (CI −0.89, 2.29)
MD (6 hours) = 1.00 (CI −0.77, 2.77)
MD (24 hours) = 0.00 (SE 0.91, 95% CI −1.77 to 1.77)
Duration of the painful episode in adults
1 (Al-Jama et al. 1999)isoxsuprinepethidineThe median duration of the painful episode did not differ significantly between the isoxsuprine group (24 hours, range 8–120) compared with the opioid group (48 hours, range 24–168, p =0.44)LowImportant
Length of stay (LOS) in adults
1 (Al-Jama et al. 1999)isoxsuprinepethidineThere was no significant difference in the median duration of hospitalisation in the isoxsuprine group (72 hours, range 24–288) compared with the meperidine group (72 hours, range 24–216, p = 0.7)LowCritical

Abbreviations: CI, confidence interval; MD, mean difference.

From: 2, Evidence review and recommendations

Cover of Sickle Cell Acute Painful Episode
Sickle Cell Acute Painful Episode: Management of an Acute Painful Sickle Cell Episode in Hospital.
NICE Clinical Guidelines, No. 143.
Centre for Clinical Practice at NICE (UK).
Copyright © 2012, National Institute for Health and Clinical Excellence.

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