Role of regional anesthesia in patients with acute sickle cell pain: A scoping review

Rizvi, Munaza; Kessler, David; Rabiner, Joni E.

doi:10.1002/pbc.30063

Cited by 2 publications

(1 citation statement)

References 60 publications

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“…Retrospective case reports have also demonstrated favorable outcomes with a reduced need for opioids, shorter hospitalization durations, and enhanced patient satisfaction in cases of isolated limb vaso-occlusive crisis (VOC) [42]. Although there are no randomized clinical trials investigating the long-term effectiveness and safety of local regional anesthesia (LRA) in VOC, the available data strongly advocate for the inclusion of LRA in the treatment of painful VOC.…”

Section: Discussionmentioning

confidence: 99%

Pain Control for Sickle Cell Crisis, a Novel Approach? A Retrospective Study

Rollé,

Vidal,

Laguette

et al. 2023

Medicina

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Background and Objectives: Pain management poses a significant challenge for patients experiencing vaso-occlusive crisis (VOC) in sickle cell disease (SCD). While opioid therapy is highly effective, its efficacy can be impeded by undesirable side effects. Local regional anesthesia (LRA), involving the deposition of a perineural anesthetic, provides a nociceptive blockade, local vasodilation and reduces the inflammatory response. However, the effectiveness of this therapeutic approach for VOC in SCD patients has been rarely reported up to now. The objective of this study was to assess the effectiveness of a single-shot local regional anesthesia (LRA) in reducing pain and consequently enhancing the management of severe vaso-occlusive crisis (VOC) in adults with sickle cell disease (SCD) unresponsive to conventional analgesic therapy. Materials and Methods: We first collected consecutive episodes of VOC in critical care (ICU and emergency room) for six months in 2022 in a French University hospital with a large population of sickle cell patients in the West Indies population. We also performed a systematic review of the use of LRA in SCD. The primary outcome was defined using a numeric pain score (NPS) and/or percentage of change in opioid use. Results: We enrolled nine SCD adults (28 years old, 4 females) for ten episodes of VOC in whom LRA was used for pain management. Opioid reduction within the first 24 h post block was −75% (50 to 96%). Similarly, the NPS decreased from 9/10 pre-block to 0–1/10 post-block. Five studies, including one case series with three patients and four case reports, employed peripheral nerve blocks for regional anesthesia. In general, local regional anesthesia (LRA) exhibited a reduction in pain and symptoms, along with a decrease in opioid consumption post-procedure. Conclusions: LRA improves pain scores, reduces opioid consumption in SCD patients with refractory pain, and may mitigate opioid-related side effects while facilitating the transition to oral analgesics. Furthermore, LRA is a safe and effective procedure.

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Section: Discussionmentioning

confidence: 99%

Pain Control for Sickle Cell Crisis, a Novel Approach? A Retrospective Study

Rollé,

Vidal,

Laguette

et al. 2023

Medicina

View full text Add to dashboard Cite

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Comment on: Role of regional anesthesia in patients with acute sickle cell pain: A scoping review

Oweidat,

Marian,

Seering

et al. 2023

Pediatric Blood & Cancer

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We read with interest the review elaborating on the role of regional anesthesia (RA) in patients with acute sickle cell pain by Rizvi and colleagues. The authors correctly summarize that RA can be a vital component of a multimodal analgesia regimen in patients getting admission for sickle cell crisis (SCC). 1 As seen in the review, the main modality often offered for these patients is epidural analgesia as, truncal pain is a significant component of SCC commonly presenting in the F I G U R E 1 Number of patients with sickle cell anemia on anticoagulant usage at admission ove the years (2014-2023).form of chest, abdominal, or pelvic pain. Additionally, lumbar epidurals may also be effective analgesic modality for SCC presenting with lower extremity pain.We would like to highlight a crucial aspect pertinent to performing RA in these patients that perhaps was not covered in this comprehensive review. One of the pre-procedural checklists before we can perform a RA technique is to ensure that a patient is not at a higher risk of bleeding complications from the procedure. Patients with SCC have

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Role of regional anesthesia in patients with acute sickle cell pain: A scoping review

Cited by 2 publications

References 60 publications

Pain Control for Sickle Cell Crisis, a Novel Approach? A Retrospective Study

Pain Control for Sickle Cell Crisis, a Novel Approach? A Retrospective Study

Comment on: Role of regional anesthesia in patients with acute sickle cell pain: A scoping review

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