Pain and Analgesia in Children with Cancer after Hemipelvectomy: A Retrospective Analysis

Area of Science:

• Pediatric Oncology
• Surgical Pain Management
• Sarcoma Treatment

Background:

• Limited data exists on the perioperative pain experience in children undergoing hemipelvectomy for primary bone and soft tissue sarcomas.
• Hemipelvectomy is a major surgical procedure often associated with significant pain and functional deficits.

Purpose of the Study:

• To describe the incidence, severity, and evolution of perioperative pain and function in pediatric oncology patients undergoing hemipelvectomy.
• To detail the analgesic regimens utilized in these patients during the perioperative period.

Main Methods:

• Retrospective chart review of pediatric cancer patients (aged ≤21 years) who underwent hemipelvectomy.
• Data collected included pain scores, analgesic use (route, type, dose, duration), and functional outcomes (ambulation).
• Analysis included 8 patients treated at MD Anderson Cancer Center between 2018 and 2021.

Main Results:

• Mean age at operation was 13 years.
• All patients received opioids and acetaminophen; mean pain scores were highest on post-operative days 0, 5, and 30.
• Mean opioid use peaked on post-operative day 5. 75% of patients achieved ambulation, with a mean time to ambulation of 5.33 days.

Conclusions:

• A multimodal analgesic approach combining acetaminophen, opioids, regional analgesia, NSAIDs, gabapentin, and/or ketamine was effective.
• Excellent functional outcomes, including ambulation, were achieved in a majority of pediatric patients following hemipelvectomy.