LAUSR

Current pain pharmacotherapy for acute moderate to severe vaso-occlusive episodes (VOEs) in patients with sickle cell disease (SCD) consists of the administration of non-steroidal antiinflammatory drugs (NSAIDs) and opioids. The National Heart, Lung, and Blood Institute (NHLBI) guidelines for acute pain crises recommend the administration of parenteral opioids within <30 min of triage and < 60 min of presentation to the emergency department (ED). 1 Therefore, it is important that the therapies used in the ED be not only effective but easily and quickly administered. Intranasal fentanyl (INF), a safe and effective parenteral analgesia for the management of VOEs in children with SCD, is both easy to administer and rapid in onset. 2 In their article published in this issue of the American Journal of Hematology , Rees et al. performed a retrospective chart review of 400 patients with SCD in 20 different hospitals to investigate the relationship between the administration of upfront INF and the likelihood a patient would be discharged from the ED preventing in-patient admission. 3 In their review, 19% of patients had been given INF during their time in the ED. When including all sites, the use of upfront INF, as opposed to intravenous (IV) opioids, was nine times more likely to be associated with discharge from the ED (OR 8.99, CI 2.81 – 30.56