i) In the Introduction section, authors have mentioned "IV diclofenac is the current standard of care for management of skeletal VOCs in SCD" [1] but the guidelines suggest the management of acute pain in sickle cell VOC is based on the severity of pain. In patients with mild to moderate pain, non-steroidal anti-inflammatory drugs (NSAIDS) can be used, unless contraindicated, whereas opioids are recommended as first line drugs in patients with severe pain [2].

ii) Authors have stated that oral NSAIDs are associated with gastric side effects [1]. The primary mechanism of gastritis by NSAIDs is by inhibition of prostaglandin production which is caused by both oral and parenteral NSAIDs [3]. Albeit less common, the risk of gastritis with parenteral NSAIDs cannot be ruled out.

iii) IV acetaminophen dose ranges from 10-15 mg/kg/dose and its effect lasts for 4-6 hours [4]. We fail to understand why paracetamol was given at 10 mg/kg/dose at 8-hour intervals.

iv) In the methodology section, authors have mentioned that patients who did not improve after home-based care and were symptomatic within 24 hours were included in this study. Many of these patients would have taken oral NSAIDs, particularly diclofenac, before reaching hospital. These patients should have been excluded from the study, as this could have an impact on the overall response rate.

v) In the result section, we found only 5 (4.91%) patients required add on therapy out of 102 patients included in this study, which signifies a remarkable response to both these drugs in acute crisis. Mean (SD) number doses required for complete relief of pain were 6 (4) and 8 (4) in the acetaminophen and diclofenac group, respectively. In our opinion patients who had more than 50% reduction in pain within 24 hours could have been switched over to oral drugs rather than prolonged parenteral therapy.