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Nerve sheath catheter analgesia for forequarter amputation in paediatric oncology patients

R N Kaddoum1, L L Burgoyne, J A Pereiras

  • 1Division of Anesthesia, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.

Anaesthesia and Intensive Care
|August 28, 2013
PubMed

Insights

This study explored pain management in children with upper limb osteosarcoma undergoing amputation. Nerve sheath catheters provided effective postoperative pain relief, enabling outpatient treatment for most patients.

Area of Science:

  • Pediatric Oncology
  • Pain Management
  • Surgical Oncology

Background:

  • Osteosarcoma is a rare bone cancer primarily affecting children and adolescents.
  • Upper limb osteosarcoma often requires aggressive treatment, including forequarter amputation.
  • Effective pain management is crucial for improving outcomes and quality of life in these young patients.

Observation:

  • Four pediatric patients (7-10 years) with upper limb osteosarcoma received chemotherapy and forequarter amputation.
  • All patients experienced preoperative pain and were managed with gabapentin.
  • Intraoperative placement of brachial plexus nerve sheath catheters allowed for postoperative local anesthetic infusion.

Findings:

  • Nerve sheath catheters facilitated multimodal analgesia, with three of four patients treated as outpatients.
  • All patients reported phantom limb pain post-surgery, but it resolved within four weeks.
  • This approach demonstrated feasibility and potential for effective pain control in pediatric amputation.

Implications:

  • Nerve sheath catheters represent a promising technique for managing acute postoperative pain in pediatric limb amputations.
  • Outpatient management may be feasible for select pediatric patients undergoing forequarter amputation with advanced pain control.
  • Further research is warranted to optimize this technique and assess long-term outcomes.

Keywords:
local anaestheticmultimodal analgesia forequarter amputationnerve sheath catheter blockosteosarcomaphantom limb pain

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