Sickle Cell, PCA, and Pruritus Management

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drk

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Is there any consensus on the management of pruritus when sicklers (or anyone) is on a PCA? Many of them request IV Benadryl and there is the concern for the "extra high" and over sedation.

Some attendings are more lenient with it when a patient is on high doses of PCA >1mg dilaudid Q6Min. Others are more lenient as sicklers have a pretty crappy time with their pain crisis and adding itching on top if it just sucks. Others are just strictly we don't care PO or nothing.

I tried doing a literature review and didn't see anything definitive on it.

Was wondering what our hematology fellows have experienced and their thoughts on it. It's a pretty common request and when I see a patient in obvious pain crisis and scratch marks all over his/her body I would feel more lenient towards the intravenous form.

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