Objective of the Study :
To study the effect of L-Arginine in sickle cell pain crises.
Methodology:
Sixty consecutive known patients of sickle cell disease (ss) with vasoocclusive pain crisis admitted to general medical ward were taken into study. Routine relevant haematological and other study were done for every patients. L-Arginine 8 gm/day in divided doses 8 hourly was given orally to 30 patients of trial group with consent of patients or their relatives along with current therapy of controlled gentle hydration. Oxygen and analgesic. Control group patients were managed with same current conservative therapy but without L-Arginine . Rating of pain scale was done daily 8 hourly.

Observation:
There were 22 male and 8 females on trial group and 24 male and 6 female in control group. Age range was between 15-35 years. 17 cases (56.7%) were age range between 15-20 years in trial group and 18 cases (60%) in control group. At presentation patients were classified in 3 group according to pain scale (0-10) into mild, moderate and severe pain . Trial group has mild pain in 2 cases (6.6%), moderate pain in 14 cases (46.7%), severe pain in 14 Cases (46.7%) and in control group mild pain in 2 cases (6.6%), moderate pain in 15 (50%) and severe pain in 13 cases (43.4%). There was no adverse effects due to L-arginine in this study in short term.

Resolution of pain after giving L-arginine in trial group with mild , moderate and severe pain was 48 hours , 60 hours and 88 hours respectively in comparison to control group with mild moderate and severe pain, which was 72, 96 and 128 hours respectively. There was a difference of decreased pain duration in trial group by 24 hour , 36 hours and 40 hours respectively.

Conclusion:
From this study it is concluded that administration of L-arginine in sickle cell pain crisis along with conventional conservative therapy can lessen the duration of pain crisis in comparison to conservative therapy alone. Patients having severe pain at the time of admission took longer time to pain resolution in both groups. However randomized double blind placebo controlled intention to treat trial should be done in large number of patients in multicentre to conclude its effectiveness.