Parenteral narcotic administration is the primary approach to the management of VOC pain in SCA. Since evidence suggests an inflammatory component for this pain, we undertook a prospective, double blind study comparing analgesia provided by intravenous morphine to ketorolac, a non-steroidal anti-inflammatory agent that has strong analgesic effects and which can be administered parenterally. Subjects were adolescents with SCA who required hospitalization for control of pain. They were randomly assigned to continuous infusion morphine with IV boluses of normal saline every 6 hours or continuous infusion normal saline with IV boluses of ketorolac every 6 hours. Additional morphine was given to all subjects when they indicated analgesia was inadequate. Two patients required extra doses of morphine but both later failed the study medication due to inadequate analgesia. Both had been assigned to the morphine arm and ultimately required high doses of morphine for pain control. Both were excluded from the final data analysis. Analgesia was assessed twice daily by a senior resident who scored observed pain behavior from 1-5 with 5 representing the most severe pain. Eight pain episodes in four patients were eligible for analysis. The average pain score and total days in hospital are summarized in the followingtable. We conclude that intravenous ketorolac may be as effective as morphine in the management of sickle related pain. A larger trial is needed to confirm this observation.

Table 1
Full size table