Doctors treating pediatric patients with sickle cell disease (SCD) for pain associated with a vaso-occlusive crisis (VOC) often have few optimal therapy options. But a recent study reviewed a technique that shows potential for mitigating pain in child SCD patients who are experiencing VOC. The technique relies on the use of local anesthetics in what are known as continuous peripheral nerve blocks, or cPNB.
The study, “Sciatic (Popliteal Fossa) Catheter for Pediatric Pain Management of Sickle Cell Crisis: A Case Report,” was published in the journal A&A Case Reports.
A hallmark of sickle cell disease, VOC is a chronic inflammatory state marked by severe pain and caused by a blockage of blood vessels. VOCs are the most common cause of emergency room visits and hospitalizations among sickle cell patients. They can severely affect a patient’s quality of life and sometimes lead to death.
Pain treatment during VOC is often ineffective, particularly for pediatric patients, and few alternatives exist to opioid therapies. Low-dose ketamine and the administration of continuous epidural analgesia have been effective for pain control in children hospitalized for VOC, but they have several side effects.
In a case involving a 14-year-old boy with SCD, study authors described using local anesthetics continuously administered via cPNB, which entails inserting an ultrasound-guided needle or catheter parallel to a nerve to numb the nerve and peripheral tissue. The authors found the procedure to be generally safe, effective, and with few adverse effects.
Administering anesthetics via cPNB can provide pain control by targeting key mechanisms involved in VOC while maintaining a child’s functional status, the authors said.
In addition to VOC pain, the pediatric patient in this study experienced numbness and a cold sensation in his right ankle. Treatment with standard pain therapies had little effect, and the patient had a pain scale score of 9 out of 10.
With ultrasound guidance, the clinical team placed a catheter in the back of the patient’s knee joint region and continuously administered local anesthetics to block the sciatic nerve and reduce the pain sensation in the affected area (the right ankle).
“Immediately after the initiation of CPNB, the patient’s pain score decreased to 3 of 10, and decreased further to 0 to 2 of 10 during the day,” the authors reported.
That allowed doctors to reduce the patient’s opioid use by 30%. cPNB also mitigated the VOC episode more quickly than standard treatment, reducing hospitalization time.
“We believe CPNBs to be an effective therapy for localized refractory pain during an acute VOC in the pediatric population that can reduce inflammation, improve pain control, decrease opioid usage, and allow faster recovery with preservation of motor function,” the authors wrote.