Regional anesthesia for sickle cell disease vaso‐occlusive crisis: A single‐center case series

Abstract

Pain management is challenging for patients with sickle cell disease (SCD) who present in vaso‐occlusive crisis (VOC). Opioid therapy is highly effective, nevertheless undesirable side effects can hinder their effectiveness. Regional anesthesia with deposition of perineural anesthetic offers nociceptive blockade, local vasodilatation, and reduces the inflammatory response. Among pediatric patients, continuous peripheral nerve block (CPNB) for perioperative adjunctive analgesia is safe. Herein, we describe the trajectory of a cohort of pediatric SCD patients with opioid‐refractory upper‐extremity VOC following placement of CPNBs for analgesia; highlighting reduced opioid consumption, improved pain scores, and decreased length of hospitalization.

Consensus definition of essential, optimal, and suggested components of a pediatric sickle cell disease center

“…A pain management specialist is optimal; while opioid and nonopioid pain medications are the mainstay of SCD pain management and can typically be managed by a hematologist, newer treatments, such as ketamine and regional anesthesia, are gaining support. 15,22 Optimal physical spaces include a dedicated outpatient clinic, dedicated inpatient unit, and day hospital/infusion center. Children and adults benefit from care for vaso-occlusive pain in an infusion center compared with the ED, with more rapid analgesia administration and lower likelihood of hospitalization.…”

“…Optimal members of the multidisciplinary team include advanced practice providers who expand the SCD team's capacity; dedicated inpatient nursing staff; and physical therapy and expressive therapies (art, music, child life). A pain management specialist is optimal; while opioid and nonopioid pain medications are the mainstay of SCD pain management and can typically be managed by a hematologist, newer treatments, such as ketamine and regional anesthesia, are gaining support 15,22 . Optimal physical spaces include a dedicated outpatient clinic, dedicated inpatient unit, and day hospital/infusion center.…”

Consensus definition of essential, optimal, and suggested components of a pediatric Sickle Cell Disease Center

“…A pain management specialist is optimal; while opioid and non-opioid pain medications are the mainstay of SCD pain management and can typically be managed by a hematologist, newer treatments, such as ketamine and regional anesthesia, are gaining support. 15,21 Optimal physical spaces include a dedicated outpatient clinic, dedicated inpatient unit, and day hospital/infusion center. Children and adults benefit from care for vaso-occlusive pain in an infusion center compared to the ED, with more rapid analgesia administration and lower likelihood of hospitalization.…”

Still seeking balance in opioid management for acute sickle cell disease pain

“…Recent work has shown promise targeting nociception with lidocaine and central sensitization with ketamine 8 . Working with pain management teams who can provide regional anesthesia such as nerve blocks may improve analgesia while limiting systemic opioid exposure 9 . The search for agents that may speed resolution of vaso‐occlusion continues, with a current NHLBI‐funded trial Sickle Cell Disease Treatment with Arginine Therapy (STArT) Trial (NCT # NCT04839354).…”

“…8 Working with pain management teams who can provide regional anesthesia such as nerve blocks may improve analgesia while limiting systemic opioid exposure. 9 The search for agents that may speed resolution of vaso-occlusion continues, with a current NHLBI-funded trial Sickle Cell Disease Treatment with Arginine Therapy (STArT) Trial (NCT # NCT04839354). Nonpharmacological pain management strategies, such as virtual reality and cognitivebehavioral therapies, have shown promise in reducing pain experiences and should be incorporated in multidisciplinary pain management plans.…”