Epidural analgesia for treatment of a sickle cell crisis during pregnancy.

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.