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

IF 1.3 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine Pub Date : 2025-07-18 DOI:10.1016/j.jemermed.2025.07.026

Pranita Kaginele MD, Tyler Najac MD, Jonathan Maik DO

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引用次数: 0

Abstract

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.

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早期超声引导神经阻滞治疗镰状细胞疼痛危机：一种新的疼痛管理方法

背景镰状细胞病（SCD）患者的疼痛管理对急诊医生（EPs）来说是一个挑战。目前急诊科（ED）对SCD患者疼痛管理的建议包括快速分诊和静脉注射阿片类药物控制疼痛，其次是其他辅助镇痛模式。区域麻醉被推荐作为一种可能的辅助治疗选择，但通常是在住院过程的后期而不是在ED中进行。病例报告：一名29岁男性SCD患者在右侧比左侧更严重的血管闭塞危象中，双侧髋关节疼痛，在x线检查中发现双侧髋关节早期无血管坏死。他接受了多剂量静脉注射氢吗啡酮用于镇痛，并等待进一步的疼痛治疗。超声引导下0.5%罗哌卡因进行囊周神经群阻滞，患者30分钟后疼痛明显减轻。患者在神经阻滞后能够行走，然后从急诊科出院，门诊随访。为什么急诊医生应该意识到这一点区域麻醉可以作为血管闭塞危象疼痛管理的早期方法，它可以帮助减少住院次数，减少阿片类药物的使用，缩短住院时间。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Emergency Medicine 医学-急救医学

CiteScore

2.40

自引率

6.70%

发文量

339

审稿时长

2-4 weeks

期刊介绍： The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine