Multimodal anesthesia for hemicorporectomy suggests creating a standardized anesthesia guideline: a case report

First performed in 1960, hemicorporectomy, or translumbar amputation, is a rare surgery performed as a last resort for patients with life-threatening diagnoses. While rare, it is associated with significant challenging events for the anesthesiologist. Here we present a challenging hemicorporectomy case which was successfully managed using a multimodal anesthesia approach.

The patient was a 40-year-old patient presenting for completion of a hemicorporectomy via a left hemipelvectomy for pelvic chondrosarcoma. The patient underwent hemicorporectomy under epidural and total intravenous anesthesia supplemented with ketamine and lidocaine infusion. The surgery lasted 17.5 h and resulted in 28 L of blood loss. The patient noted excellent pain control and was discharged on postoperative day 74 following an uncomplicated hospital course and in-house rehabilitation.

Reviewing the literature, we recognized that there are no standardized anesthesia protocols published for hemicorporectomy. Based on our case report we present a novel anesthesia strategy that addresses almost all major challenges with hemicorporectomies. Our successful strategy suggests that a total intravenous anesthesia with propofol in combination with an epidural and a multimodal pain regimen with rate adjustments based on body mass reduction should be considered as a standard anesthesia protocol for hemicorporectomies. We recommend establishing a state-of-the-art anesthesia guideline for patients undergoing hemicorporectomy and encourage anesthesiologists to publish case reports describing the anesthesia approach for a hemicorporectomy.