Early Ultrasound-Guided Nerve Blocks for Sickle Cell Pain Crisis: A Novel Approach to Pain Management.

BACKGROUND

Pain management in patients with sickle cell disease (SCD) can be challenging for emergency physicians (EPs). Current emergency department (ED) recommendations for pain management in patients with SCD include rapid triage and pain control with intravenous opioids, followed by other adjunctive modes of analgesia. Regional anesthesia is recommended as a possible adjunct treatment option, but is generally performed later in the hospital course rather than in the ED.

CASE REPORT: A 29-year-old man with SCD presented to the ED in a vaso-occlusive crisis in the setting of right worse than left, bilateral hip pain, and was found on x-ray study to have early avascular necrosis of the bilateral hips. He received multiple doses of intravenous hydromorphone for analgesia and was pending admission for further pain management. An ultrasound-guided pericapsular nerve group block was performed with 0.5% ropivacaine, resulting in a considerable reduction in the patient's pain after 30 min. The patient was able to ambulate after the nerve block and was then discharged from the ED with outpatient follow-up.

WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS: Regional anesthesia can be used as an early method of pain management in vaso-occlusive crises, which can help reduce hospital admissions, reduce opiate use, and decrease hospital length of stay.