Effective Pain Management After Total Hip Arthroplasty in a Sickle Cell Patient Emphasizing Dexamethasone Sodium Phosphate/Methylprednisolone Acetate Administered via a Peripheral Nerve Blockade: A Case Report

A A Pract. 2019 Mar 1;12(5):171-175. doi: 10.1213/XAA.0000000000000877.

Abstract

Pain control after total hip arthroplasty in sickle cell patients is challenging yet essential to prevent sickle cell crises or protracted hospital stays. We present a case of effective analgesia that lasted for weeks in a young opioid-tolerant female. This was achieved by the administration of glucocorticoids with different durations of action, dexamethasone sodium phosphate/methylprednisolone acetate, via a femoral/lateral femoral cutaneous nerve block placed preoperatively. Postoperatively, the patient's opioid demand was unchanged from her preoperative baseline. She met all the discharge requirements, including physical therapy targets, on postoperative day 2 and did not have any complications during the hospitalization.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anemia, Sickle Cell / diagnosis
  • Anemia, Sickle Cell / surgery*
  • Anti-Inflammatory Agents / administration & dosage*
  • Arthroplasty, Replacement, Hip / adverse effects*
  • Autonomic Nerve Block / methods*
  • Dexamethasone / administration & dosage
  • Dexamethasone / analogs & derivatives*
  • Female
  • Glucocorticoids / administration & dosage
  • Humans
  • Methylprednisolone Acetate / administration & dosage*
  • Pain Management / methods*
  • Treatment Outcome

Substances

  • Anti-Inflammatory Agents
  • Glucocorticoids
  • dexamethasone 21-phosphate
  • Methylprednisolone Acetate
  • Dexamethasone