Epidural Analgesia for Treatment of a Sickle Cell Crisis During Pregnancy

Abstract

Epidural anesthesia should be considered as a potentially effective treatment for a severe sickle cell crisis in obstetric patients.

Prophylactic red blood cell exchange may be beneficial in the management of sickle cell disease in pregnancy

“…Maternal mortality, as well as the incidence of cesarean section, preterm labor, and pregnancy morbidity, is higher among females with SCD. More than 50% of obstetric patients with SCD will have a pain crisis during pregnancy, and the management of these can be challenging . In our study, there were no crises during pregnancy among the SCD patients who underwent prophylactic RBCX procedures.…”

“…More than 50% of obstetric patients with SCD will have a pain crisis during pregnancy, and the management of these can be challenging. 39 In our study, there were no crises during pregnancy among the SCD patients who underwent prophylactic RBCX procedures. Koshy and colleagues 29 showed that prophylactic transfusion significantly reduced the incidence of painful crisis of SCD and substantially reduced the cumulative incidence of other complications in pregnant women during gravidity.…”

Management of Refractory Pain in Hospitalized Adolescents With Sickle Cell Disease

“…This approach has not been widely adopted, perhaps in part because of the unfamiliarity of this procedure to most hematologists, and the uncertainty of the need for an invasive procedure early in the course of episode that may be effectively managed with IV analgesics. However, a number of case reports have described the use of epidural analgesia in adults with SCD and sickle cell pain during pregnancy, 6,7 or during labor/delivery, 8 both clinical situations where there is a clinical imperative to limit systemic opioid exposure.…”

“…Opioids, with or without local anesthetics, are given using an epidural catheter that can be placed either under sedation in a minor procedure room, or depending on the monitoring capability, in a procedure room on the floor. A number of previous case reports and small case series have described the use of epidural analgesia during painful episodes, [6][7][8][9] however, this technique has not been widely adopted in this setting. We present our clinical experience in 7 of our sickle cell patients who received epidural analgesia for persistent refractory pain.…”

Sickle cell crisis and pregnancy

“…There are also reports of successful pain control with epidural analgesia in the antepartum setting, especially if traditional interventions are not providing relief. 14 …”