More than 50% of obstetric patients with sickle cell disease will have a pain crisis during pregnancy, and the management of these cases can be challenging.
A 20-year-old African American with sickle cell disease presented at 29 4/7 weeks of gestation with severe, debilitating leg and back pain. Large doses of intravenous narcotics did not result in significant pain relief, so a lumbar epidural was placed. This resulted in complete pain relief within several minutes. The patient's symptoms resolved over several days and after a short course of narcotics she was discharged to home, and the remainder of her pregnancy was uncomplicated.
Epidural anesthesia should be considered as a potentially effective treatment for a severe sickle cell crisis in obstetric patients.
Epidural analgesia can provide effective pain control for obstetric patients with severe pain due to a sickle cell crisis.
From the Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD; Department of Anesthesiology, Johns Hopkins University, Baltimore, MD.
Corresponding Author: Abigail D. Winder, MD, Johns Hopkins University, Department of Gynecology and Obstetrics, 600 North Wolfe Street, Phipps 279, Baltimore, MD 21287; e-mail: firstname.lastname@example.org.
Financial Disclosure The authors did not report any potential conflicts of interest.