Evaluation of the Efficacy of Intra-nasal Sufentanil for Analgesia of Vaso-occlusive Crisis in Sickle-cell Adults.

Inclusion Criteria:

• Age 18 to 75 years old;
• Sickle-cell patient.
• Signs of a vaso-occlusive crisis (migratory bone pain, which may occur in the limbs,spine, thorax, pelvis, skull) or crisis known as such by the patient;
• Severe pain (NRS ≥ 6/10) on admission to the ED;
• Registered with the social security scheme or his beneficiaries (except AME)
• Signature of free and informed consen.

Exclusion Criteria:

• Strong opioids received in the previous 6 hours;
• Pregnancy or breastfeeding;
• Woman not menopausal nor sterile without effective contraception (HAS criteria)
• Oxygen saturation below 93%;
• Patients who cannot cooperate because of a State of agitation or a Cognitiveimpairment
• Unable to communicate;
• Unable to do self-assessment;
• Allergy or intolerance to opiates or nitrous oxide.
• Abuse or addiction to opioids
• Liver insufficiency
• Renal insufficiency
• Severe asthma or chronic obstructive bronchopulmonary disease
• Pulmonary disease necessitating oxygen
• Presence of seriousness signs:
• All respiratory seriousness signs
• all neurologic signs or consciousness impairment (coma Glasgow scale under 15)
• hyperthermia over than 39°C
• Signs of intolerance of acute anemia
• Signs of hemodynamic failure
• Known organ failure (renal insufficiency, pulmonary high blood pressure)
• A description by the patient of a non usual crisis.
• Current treatment with nasal vasoconstrictors is ongoing
• Head injury with suspicion of high intracranial pressure
• Severe thoracic trauma or decompensated respiratory insufficiency
• Contraindications of intranasal administration:
• Facial trauma
• Nose or sinusal surgery in the previous 6 months before inclusion
• Chronic nose and upper airway alteration (ex. facial malformation)
• Acute nose and upper airway alteration (ex. Epistaxis, acute respiratoryinfection, sinusitis).
• Contraindication to nitrous oxide
• Contraindication to morphine
• Patient's refusal to participate in the study.
• Previous inclusion in the study of less than 14 days.