Fentanyl buccal tablet: a new breakthrough pain medication in early management of severe vaso-occlusive crisis in sickle cell disease.

Background: Sickle cell disease (SCD) is a worldwide distributedhereditary red cell disorder. The principal clinicalmanifestations of SCD are the chronic hemolytic anemiaand the acute vaso-occlusive crisis (VOCs), which are mainlycharacterized by ischemic/reperfusion tissue injury. Pain is themain symptom of VOCs, and its management is still achallenge for hematologists, requiring a multidisciplinaryapproach.Methods: We carried out a crossover study on adult SCDpatients, who received two different types of multimodalanalgesia during two separate severe VOCs with time intervalbetween VOCs of at least 6 months. The first VOC episodewas treated with ketorolac (0.86 mg/kg/day) and tramadol(7.2 mg/kg/day) (TK treatment). In the second VOC episode,fentanyl buccal tablet (FBT; 100 lg) was introduced in asingle dose after three hours from the beginning of TKanalgesia (TKF treatment). We focused on the first 24 hoursof acute pain management. The primary efficacy measurewas the time-weighted-sum of pain intensity differences(SPID24). The secondary efficacy measures included the painintensity difference (PID), the total pain relief (TOTPAR), andthe time-wighted sum of anxiety (SAID24).Results: SPID24 was significantly higher in TKF than in TKtreatment. All the secondary measures were significantlyameliorated in TKF compared to TK treatment, without majoropioid side effects. Patients satisfaction was higher with TKFtreatment than with TK one.Conclusions: We propose that VOCs might require breakthroughpain drug strategy as vaso-occlusive phenomenaand enhanced vasoconstriction promoting acute ischemicpain component exacerbate the continuous pain of VOCs.FBT might be a powerful and feasible tool in early management of acute pain during VOCs in emergencydepartments.