For decades the therapy for severe vaso-occlusive crisis (VOC) in sickle cell disease (SCD) has been administration of intravenous (IV) fluids and parenteral opioids. Little attention has been given to alteration of vascular tone as a therapeutic modality. Phentolamine (P), a rapidly acting α adrenergic antagonist, produces vasodilation and could increase blood flow to ischemic areas producing a beneficial effect. We administered P to 4 patients with SCD (4-26 yrs) with multiple hospitalizations for VOC from 1/1993 to 12/1995. P was given as an IV infusion (0.8 to 3.3 μg/kg/min) during 8 episodes of VOC (1-3 episodes/patient). These same 4 patients had 40 other hospitalizations for VOC when no P was administered. All patients received IV fluids and parenteral opioids as ordered by their physicians. No adverse effects of P were noted. Outcome variables were length of hospital stay (LOS) and duration of parenteral opioids (DPO). Statistical comparisons between episodes with and without P were made by t-test with data normalized to Z-scores for each patient. Results shown are Mean ± SD. Our results show that P significantly shortened the time during which parenteral opioids were given for control of pain and the length of hospital stay tended to be decreased. We conclude that P appears to have a positive therapeutic effect in VOC. Further investigation with this agent is warranted.Table

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