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Sousa B, Nunes J, Ribeiro AF. Single-centre case series report of regional anaesthesia for pain management in vaso-occlusive crisis. Indian J Anaesth 2024; 68:394-396. [PMID: 38586271 PMCID: PMC10993944 DOI: 10.4103/ija.ija_768_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 12/30/2023] [Accepted: 12/31/2023] [Indexed: 04/09/2024] Open
Abstract
Sickle cell disease is characterised by episodes of vaso-occlusive crisis, a painful complication. Regional anaesthesia has shown promising results in reducing opioid consumption and pain scores. Patients with vaso-occlusive crises who underwent regional anaesthesia in the paediatric intensive care unit were studied. Data regarding pain location, regional analgesia technique, the local anaesthetic used and dose, daily opioid consumption, daily pain scores, use of adjuvants and complications were recorded. The primary outcome was to evaluate the effect of regional anaesthesia on opioid consumption. In this study, we describe 10 cases, referring to six paediatric patients with the vaso-occlusive crisis who underwent regional anaesthesia for severe pain and were unresponsive to increasing doses of opioids. Six cases received epidural analgesia, three continuous peripheral nerve blocks and one received both techniques. Opioid consumption was reduced (58%), and pain scores decreased (72%), both statistically significant reductions.
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Affiliation(s)
- Bárbara Sousa
- Department of Anesthesiology, Hospital Professor Dr. Fernando Fonseca, Portugal
| | - Joana Nunes
- Department of Anesthesiology, Hospital Professor Dr. Fernando Fonseca, Portugal
| | - Andreia Fiúza Ribeiro
- Pediatric Special Intensive Care Unit, Hospital Professor Dr. Fernando Fonseca, Portugal
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2
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Elhamrawy A, Veneziano G, Tobias JD. Regional anesthesia and sickle cell crisis in pediatric patients: An educational-focused review. Paediatr Anaesth 2024; 34:195-203. [PMID: 37983941 DOI: 10.1111/pan.14801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Sickle cell disease (SCD) is the most common inherited hemoglobinopathy, affecting approximately 100 000 patients in United States and millions worldwide. Although the mainstay of pain management for VOC remains systemic opioids, given the potential for adverse effects including respiratory depression and hypoxemia, there remains interest in the use of regional anesthetic techniques (neuraxial or peripheral nerve blockade). METHODS A systematic search of pubMed, Scopus, and Google Scholar was conducted using the terms sickle cell disease, sickle cell crisis, pain crisis, vaso-occlusive crisis, regional anesthesia, peripheral nerve blockade, and neuraxial anesthesia. RESULTS We identified 7 publications, all of which were retrospective case series or single case reports, outlining the use of neuraxial anesthesia in a total of 26 patients with SCD. Additionally, we identified 4 publications, including one retrospective case series and 3 single case reports, entailing the use of peripheral blockade in patients with VOC and SCD. DISCUSSION The available literature, albeit all retrospective or anecdotal, suggests the potential utility of regional anesthesia to treat pain in patients with SCD. Additional benefits have included avoidance of the potential deleterious physiologic effects of systemic opioids and in one case series, an improvement in respiratory function as judged by pulse oximetry. The anecdotal and retrospective nature of the available reports with an absence of prospective trials limits the evidence based medicine available from which to develop to guidlines for the optimal local anesthetic agent to use, its concentration, the rate of infusion, and the choice of adjunctive agents.
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Affiliation(s)
- Amr Elhamrawy
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Giorgio Veneziano
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Rollé A, Vidal E, Laguette P, Garnier Y, Delta D, Martino F, Portecop P, Etienne-Julan M, Piednoir P, De Jong A, Romana M, Bernit E. Pain Control for Sickle Cell Crisis, a Novel Approach? A Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2196. [PMID: 38138299 PMCID: PMC10744599 DOI: 10.3390/medicina59122196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/29/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
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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Affiliation(s)
- Amélie Rollé
- Anesthesiology and Intensive Care Department, University Hospital of La Guadeloupe, F-97139 Les Abymes, France; (E.V.); (P.L.); (F.M.); (P.P.)
- Université Paris Cité and Université des Antilles, INSERM, BIGR, F-75015 Paris, France; (Y.G.); (M.E.-J.); (M.R.)
| | - Elsa Vidal
- Anesthesiology and Intensive Care Department, University Hospital of La Guadeloupe, F-97139 Les Abymes, France; (E.V.); (P.L.); (F.M.); (P.P.)
| | - Pierre Laguette
- Anesthesiology and Intensive Care Department, University Hospital of La Guadeloupe, F-97139 Les Abymes, France; (E.V.); (P.L.); (F.M.); (P.P.)
| | - Yohann Garnier
- Université Paris Cité and Université des Antilles, INSERM, BIGR, F-75015 Paris, France; (Y.G.); (M.E.-J.); (M.R.)
| | - Delphine Delta
- West-Indies Faculty of Medicine, University of The French West-Indies, F-97157 Pointe à Pitre, France;
| | - Frédéric Martino
- Anesthesiology and Intensive Care Department, University Hospital of La Guadeloupe, F-97139 Les Abymes, France; (E.V.); (P.L.); (F.M.); (P.P.)
| | - Patrick Portecop
- Emergency Department, University Hospital of Guadeloupe, F-97100 Pointe à Pitre, France;
| | - Maryse Etienne-Julan
- Université Paris Cité and Université des Antilles, INSERM, BIGR, F-75015 Paris, France; (Y.G.); (M.E.-J.); (M.R.)
- Sickle Cell Disease Unit, Reference Centre for Sickle Cell Disease, Thalassemia and Other Red Cell Rare Diseases, CHU de la Guadeloupe, CEDEX, F-97159 Pointe à Pitre, France;
| | - Pascale Piednoir
- Anesthesiology and Intensive Care Department, University Hospital of La Guadeloupe, F-97139 Les Abymes, France; (E.V.); (P.L.); (F.M.); (P.P.)
| | - Audrey De Jong
- Anesthesia and Critical Care Department, Saint Eloi Teaching Hospital, University Montpellier 1, 80 Avenue Augustin Fliche, CEDEX 5, F-34295 Montpellier, France;
- Phymed Exp INSERM U1046, CNRS UMR 9214, F-34295 Montpellier, France
| | - Marc Romana
- Université Paris Cité and Université des Antilles, INSERM, BIGR, F-75015 Paris, France; (Y.G.); (M.E.-J.); (M.R.)
| | - Emmanuelle Bernit
- Sickle Cell Disease Unit, Reference Centre for Sickle Cell Disease, Thalassemia and Other Red Cell Rare Diseases, CHU de la Guadeloupe, CEDEX, F-97159 Pointe à Pitre, France;
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Hulbert ML, Manwani D, Meier ER, Alvarez OA, Brown RC, Callaghan MU, Campbell AD, Coates TD, Frei-Jones MJ, Hankins JS, Heeney MM, Hsu LL, Lebensburger JD, Quinn CT, Shah N, Smith-Whitley K, Thornburg C, Kanter J. Consensus definition of essential, optimal, and suggested components of a pediatric sickle cell disease center. Pediatr Blood Cancer 2023; 70:e29961. [PMID: 36094289 DOI: 10.1002/pbc.29961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 12/25/2022]
Abstract
Sickle cell disease (SCD) requires coordinated, specialized medical care for optimal outcomes. There are no United States (US) guidelines that define a pediatric comprehensive SCD program. We report a modified Delphi consensus-seeking process to determine essential, optimal, and suggested elements of a comprehensive pediatric SCD center. Nineteen pediatric SCD specialists participated from the US. Consensus was predefined as 2/3 agreement on each element's categorization. Twenty-six elements were considered essential (required for guideline-based SCD care), 10 were optimal (recommended but not required), and five were suggested. This work lays the foundation for a formal recognition process of pediatric comprehensive SCD centers.
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Affiliation(s)
- Monica L Hulbert
- Division of Pediatric Hematology/Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Deepa Manwani
- Division of Pediatric Hematology/Oncology, Children's Hospital at Montefiore/Albert Einstein College of Medicine, New York, New York, USA
| | - Emily Riehm Meier
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana, USA
| | - Ofelia A Alvarez
- Division of Pediatric Hematology/Oncology, University of Miami School of Medicine, Miami, Florida, USA
| | - R Clark Brown
- Division of Pediatric Hematology/Oncology, Children's Healthcare of Atlanta/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael U Callaghan
- Division of Pediatric Hematology/Oncology, Children's Hospital of Michigan, Detroit, Michigan, USA
| | - Andrew D Campbell
- Division of Pediatric Hematology, Children's National Medical Center, Washington, District of Columbia, USA
| | - Thomas D Coates
- Cancer and Blood Disease Institute, Department of Pediatrics, Children's Hospital Los Angeles/University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Melissa J Frei-Jones
- Division of Pediatric Hematology/Oncology, University of Texas School of Medicine-San Antonio, San Antonio, Texas, USA
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Matthew M Heeney
- Dana Farber/Boston Children's Cancer and Blood Disorders Center, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Lewis L Hsu
- Division of Pediatric Hematology/Oncology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jeffrey D Lebensburger
- Division of Pediatric Hematology/Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Charles T Quinn
- Division of Pediatric Hematology/Oncology, Cincinnati Children's Hospital Medical Center and, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Nirmish Shah
- Divisions of Pediatric Hematology Oncology and Hematology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kim Smith-Whitley
- Department of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Global Blood Therapeutics, San Francisco, California, USA
| | - Courtney Thornburg
- Division of Pediatric Hematology/Oncology, Rady Children's Hospital/Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Julie Kanter
- Division of Hematology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Rizvi MB, Kessler DO, Rabiner JE. Role of regional anesthesia in patients with acute sickle cell pain: A scoping review. Pediatr Blood Cancer 2023; 70:e30063. [PMID: 36308736 DOI: 10.1002/pbc.30063] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 12/25/2022]
Abstract
Sickle cell disease is the most prevalent inherited blood disorder in the world, with significant morbidity and mortality. Patients often have recurrent painful vaso-occlusive episodes, and the American Society of Hematology gives a conditional recommendation for the use of regional anesthesia for acute sickle cell pain management. This scoping review summarizes the current evidence and identifies gaps for future research. Our screening process is outlined, and articles that mentioned the use of regional anesthesia for acute sickle cell crises were included. We present and interpret our results and highlight opportunities for future investigation.
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Affiliation(s)
- Munaza B Rizvi
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University Irving Medical Center, New York, USA
| | - David O Kessler
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University Irving Medical Center, New York, USA
| | - Joni E Rabiner
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University Irving Medical Center, New York, USA
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Fasipe TA, Hulbert ML. Still seeking balance in opioid management for acute sickle cell disease pain. Pediatr Blood Cancer 2022; 69:e29741. [PMID: 35522166 DOI: 10.1002/pbc.29741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Titilope A Fasipe
- Division of Pediatric Hematology/Oncology, Baylor College of Medicine, Houston, Texas, USA.,Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
| | - Monica L Hulbert
- Division of Pediatric Hematology/Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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