i) We agree that opioids are still the standard of care for
severe pain in SCD skeletal VOC, but IV diclofenac is the
current standard of care for management of skeletal VOCs among
HbSS children in our center, as opiates are not freely and
continuously available, there is a lack of manpower to closely
monitor respiratory depression in a high volume center, severe
constipation with regular usage of opiates, more likelihood to
develop opioid dependence in patients with severe and frequent
VOCs, and gastric side effects with regular usage of oral
NSAIDs. Moreover, we had observed that most patients coming to
us with mild to moderate pain had already taken oral NSAIDs
without relief.
Thus, due to non-availability of opioids,
observed non-response to oral NSAIDs, and possibility of
nephropathy with chronic diclofenac use, we planned this study.
ii) We agree with this statement.
iii) The dose range of IV paracetamol is
10-15 mg/kg/dose with duration varying from 4 to 8 hour,
depending upon the situation. We enrolled only those patients
who responded to 8-hourly regimen, for ease of analysis.
iv) We included only those patients who
had not received any medications, and home- based care means
only taking sufficient fluid and restricted outdoor activities
to prevent dehydration.
v) We agree that patients who had more
than 50% reduction in pain within 24 hours could have been
switched over to oral drugs therapy and the same was also done
by us. However, as our study end point was achieved, we have not
mentioned these in our manuscript.
