Thoracic Epidural Analgesia Use in Large Recurrent Desmoid Fibromatosis Resection: A Case Report

Area of Science:

• Anesthesiology
• Surgical Oncology
• Pediatric Surgery

Background:

• Desmoid tumors are rare, locally aggressive neoplasms requiring complex surgical management.
• Spinal anesthesia has been documented for desmoid tumor resection, but thoracic epidural analgesia has not been reported.
• Forequarter amputation is a radical surgical procedure for extensive tumors involving the shoulder girdle.

Observation:

• A case report details the anesthetic management of an adolescent male undergoing resection of a large recurrent desmoid tumor and forequarter amputation.
• Thoracic epidural analgesia was employed as a key component of the multi-modal anesthetic and analgesic plan.
• The procedure involved significant surgical complexity and potential for substantial post-operative pain.

Findings:

• Successful utilization of thoracic epidural analgesia during the surgical resection and forequarter amputation.
• Thoracic epidural analgesia contributed to effective pain management, potentially reducing the need for high-dose opioids post-operatively.
• No immediate complications related to de novo tumor formation were observed during the peri-operative period.

Implications:

• Thoracic epidural analgesia represents a viable adjuvant strategy for managing severe pain associated with complex desmoid tumor resections.
• Careful consideration of risks, including potential for tumor induction, is necessary when applying this technique in pediatric patients.
• Further research may explore the safety and efficacy of thoracic epidural analgesia in similar complex oncologic surgeries.