1- Interno de Anestesiologia, Centro Hospitalar de Lisboa Central
2- Interno de Anestesiologia, Centro Hospitalar de Vila Nova de Gaia
3- Assistente Hospitalar Graduado, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central
4- Chefe de Serviço, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central
- Reunião internacional - 33 Annual ESRA Congress 2014 - Sevilha
- Poster
Resumo:
Background: Ewing's sarcoma is the second most common bone sarcoma affecting children. Frequently occurs in the pelvis, arm or leg. Studies found that epidural anesthesia is more efficacious in treating postoperative pain in patients with orthopedic tumors than other modalities.
Case Report: A 12-year-old male with diagnosis of Ewing's sarcoma of the right tibia with a pulmonary metastasis. Neoadjuvant chemotherapy completing six cycles with disappearance of pulmonary metastasis and decrease size of the tibial lesion. Underwent tumour resection followed by sterilization with liquid Nitrogen and skeletal reconstruction under combined general and epidural anesthesia – tunnelled catheter space L3-L4. At fifth day post-operative the patient returned to the OR for surgical cleaning because of an infection of the wound. This complication took the patient to the OR every other day. The epidural catheter was maintained for analgesia during 31 days because the patient became dependent on the regional analgesia for pain control. Due to bone necrosis one month after the initial surgery the patient was amputated under combined anesthesia with general, epidural and a peripheral nerve block (ciatic nerve block) for prevention of phantom pain. Epidural catheter was removed at the fifth day after amputation. Laboratory culture of the catheter tip was negative.
Discussion/Conclusion: Pain after extensive limb-sparing resections of bone is severe, and difficult to control. The use of multiple analgesia modalities is ideal. The tunnelled epidural in this case proved to be effective both intra-and postoperatively; without catheter related complications. The quality of analgesia contributed to the physical and psychological recovery of the patient.
Palavras Chave: Oncological, pain, pediatrics