Opioid‑free anaesthesia and analgesia in a sickle cell disease patient with extensive orthopaedic soft‑tissue surgery

Abstract

The provision of anaesthesia through techniques devoid of opioid is referred to as opioid‑free anaesthesia. Both pain crisis in sickle cell (SC) disease and poor postoperative pain care worsens patient morbidity. This is a case report of a 22‑year‑old female SC anaemia patient, who had bilateral quadricepsplasty. Sickle Cell disease is common among individuals of African race and opioids are often abused during the out‑of‑hospital treatment of pain crisis. We report the case of pentazocine addiction resulting in severe bilateral quadriceps fibrosis. Thus, it was necessary to avoid opioid‑based anaesthesia. Acombined spinal epidural anaesthesia using magnesium adjunct was applied. The analgesic function of magnesium is linked to the blockade of the N‑methyl‑D‑aspartate receptor. The subarachnoid block was achieved with 3.5 mL of 0.5% heavy bupivacaine (17.5 mg), while epidural anaesthesia was done with 14 mL of 0.25% plain bupivacaine (37.5 mg) and 1 mL of 2 mg/kg of magnesium, (i.e., 120 mg). After the surgery, the surgical sites were infiltrated with 10 mL of 0.25% plain bupivacaine (25 mg) on each limb. Intravenous magnesium‑sulfate 5 mg/kg (i.e., 300 mg), was added to 500 mL of crystalloids to run every 4 h. Furthermore, 1 mL of 2 mg/kg magnesium, (i.e., 120 mg,) was added to the 14 mL of 0.125% plain bupivacaine to make 15 mL of magnesium–bupivacaine admixture, every 4 h. These were given for 48 h. The Visual Analog Scale pain scores reduced from 9/10 to 5‑6/10 and then to 3/10 over a 6‑h period and remained at or lower than 3/10 throughout the postoperative period. Adequate haemodynamics, oxygenation, hydration, warmth, and urine output were ensured. The postoperative period was crisis free.