This research is being done to find out the best way to give narcotics for pain relief in
adults with sickle cell disease and painful crisis. This study is a comparison of two ways
of giving narcotics. The first way is what occurs now in the Emergency Acute Care Unit
(EACU) where patients are given a single intravenous (iv) dose of a narcotic which is
repeated by the nurse as needed to control the pain. The second way is to provide a single
iv dose of narcotic and then allow the patient to push a button and receive one or more
additional doses of narcotic when he/she thinks it is needed. Our hypothesis is that PCA
will be a more effective way of controlling pain.
- Documented sickle cell disease
- Signed consent in outpatient clinic or during a prior hospitalization
- 18+ years of age
- Seen in the ED with sickle cell pain crisis - this will be based on patients chief
complaint that they are in a VOC.
- Requires IV administration of narcotics (has failed oral narcotic therapy at home)
- Must be 2 weeks since their last randomization on this study.
- Contraindication to the use of IV narcotics
- Hypotension with systolic blood pressure (SBP) ≤ 90
- Respiratory rate ≤9
- Altered mental status
- Patient unable to understand how to use the PCA device
- Patient unwilling to use PCA device
- Pulse oximeter reading of ≤ 94% on room air
- Patient is allergic to IV morphine & hydromorphone & fentanyl.
- Patient is allergic to oral hydromorphone & morphine & oxycodone
- Patient has been randomized on this study 3 times before