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 OJAnes  Vol.2 No.5 , November 2012
Use of Continuous Regional Anesthetic for Management of Pediatric Sickle Cell Crisis
Julie T. Vuong*, Milena Pilipovic
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Abstract: Sickle cell patients often find difficulty obtaining adequate treatment of pain. Anti-inflammatory medications, steroids, and opioids can reduce pain; however their use is limited by side effects. We present a 12 year old female with sickle cell disease who was admitted with severe right thigh pain secondary to acute infarction of the proximal femoral diaphysis.She was treated with intravenous hydration, ketorolac and opioids with no relief. The patient agreed to a continuous femoral nerve block, which was done under sedation. Pain relief was obtained immediately. The infusion was discontinued after 3 days and the patient was discharged the day after catheter removal with a one week supply of fentanyl patches and home dose of oral oxycodone. We suggest continuous femoral nerve block as an adjunct to treat sickle cell pain crises involving the lower extremity. Regional techniques may vasodilate and thus improve the nociceptive, vasoconstrictive pain associated with acute pain crises.
Keywords: Sickle Cell Crisis; Regional Anesthesia; Pediatric Pain
Cite this paper: J. Vuong and M. Pilipovic, "Use of Continuous Regional Anesthetic for Management of Pediatric Sickle Cell Crisis," Open Journal of Anesthesiology, Vol. 2 No. 5, 2012, pp. 228-229. doi: 10.4236/ojanes.2012.25053.
References

[1]   O. S. Platt, D. T. Bruce, J. B. Donald, F. M. Paul, F. R. Wendell, V. Elliott and R. K. Thomas, “Pain in Sickle Cell Disease—Rates and Risk Factors,” The New England Journal of Medicine, Vol. 325, No. 1, 1991, 1991, pp. 11-16. doi:10.1056/NEJM199107043250103

[2]   J. J. Field and M. R. DeBauen, “Acute Pain Management in Adults with Sickle Cell Disease,” 2012. http://medjournal.hmc.psu.edu:4219/contents/acute-pain-management-in-adults-with-sickle-cell-disease?source=search_result&search=sickle+cell+pain+management&selectedTitle = 1%7E150

[3]   R. Dunlop and K. C. L. B. Bennett, “Pain Management for Sickle Cell Disease in Children and Adults,” Cochrane Database of Systematic Reviews, No. 2. 2006, Article ID: CD003350. doi:10.1002/14651858.CD003350.pub2

[4]   J. Glassberg, “Regional Anesthesia for Sickle Cell Crisis Using Ultrasound in The Emergency Department: Phase I (RESCUED),” 2012. http://clinicaltrials.gov/ct2/show/NCT01256281

[5]   P. G. Firth, C. A. Head and D. C. David, “Sickle Cell Disease and Anesthesia,” Anesthesiology, Vol. 101, No. 3, 2004, pp. 766-785.

[6]   C. B. Berde and F. S. Navil, “Analgesics for the Treatment of Pain in Children,” The New England Journal of Medicine, Vol. 347, No. 14, 2002, 1094-1103.

[7]   M. Yaster, R. T. Joseph, B. Carol, F. C. James and D. George, “Epidural Analgesia in the Management of Severe Vaso-Occlusive Sickle Cell Crisis,” Pediatrics, Vol. 93, No. 2, 1994, pp. 310-315

 
 
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