Use of Continuous Regional Anesthetic for Management of Pediatric Sickle Cell Crisis

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.