Comparison of Patient Controlled Analgesia (PCA) Versus Bolus Narcotic Therapy for the Treatment of Vaso-Occlusive Crisis (VOC)

Inclusion Criteria: * 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. Exclusion Criteria: * 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