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Epidural analgesia for treatment of a sickle cell crisis during pregnancy
Abigail D Winder1, Stacie Johnson, Jamie Murphy
1From the Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD; Department of Anesthesiology, Johns Hopkins University, Baltimore, MD.
Background:
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.
Case:
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.
Conclusion:
Epidural anesthesia should be considered as a potentially effective treatment for a severe sickle cell crisis in obstetric patients.
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