[Epidural block for lower limb amputation in a patient with Klippel-Trenaunay-Weber syndrome]

A 23-year-old man with Klippel-Trenaunay-Weber syndrome (KTWS) was scheduled for left lower limb amputation. He had complained of severe lower limb pain. Oral administration of acetaminophen, duloxetine, and morphine did not alleviate the pain. Epidural block was performed preoperatively after confirming there were no abnormal angiomas in the lumbar spinal canal on CT scan. The pain was alleviated by the epidural block. The epidural block was also useful during the operation and postoperative pain management. There were no complications related to the epidural block. KTWS is a rare congenital malformation characterized by the triad of varicose veins, capillary malformations, and bony or soft tissue hypertrophy in affected limbs. Some patients with KTWS have epidural hemangioma and cerebral or spinal cord arteriovenous fistulas. There have been some reports of rupture of epidural hemangioma resulting in progressive paraplegia. When epidural block is scheduled for patients with KTWS, CT scan should be performed to investigate abnormal vessels in the lumbar spinal canal.