Background and aims Osteosarcoma commonly affects the distal femur of adolescents. Knee rotationplasty is a limb salvage surgery alternative to above-knee amputation for osteosarcoma around the knee. Appropriate postoperative analgesia is important to facilitate rehabilitation.
Methods An 18-year-old male (178 cm, 72 kg) with osteosarcoma at the left distal femur was planned to undergo knee rotationplasty. Anesthesia was maintained with propofol and remifentanil in combination with single-shots sciatic nerve block (0.25% levobupivacaine 20 ml) and femoral nerve block (0.25% levobupivacaine 20 ml). After wide excision of the tumor, the leg was rotated 180 degrees, and osteosynthesis was performed between the remaining femur and the tibia. The sciatic nerve was preserved, but the vessels required microsurgical anastomosis. Before the end of surgery, intravenous acetaminophen 1000 mg and flurbiprofen axetil 50 mg were administered. At the end of surgery, continuous femoral nerve block with 0.17% levobupivacaine was started at a rate of 5 ml/h and continued for 60 h postoperatively.
Results The surgical duration was 17 h 20 min. Numerical rating scale of wound pain was 0–2 until postoperative day 4. Only oral acetaminophen was added for postoperative analgesia and no opioids except for intraoperative remifentanil was required. The patient started oral fluid 4 h after surgery and subsequently advanced to a regular diet 7 h after surgery. The patient could start moving by himself using contralateral leg at 24 h after surgery.
Conclusions Continuous femoral nerve block was useful for analgesia after knee rotationplasty. Preservation of contralateral lower extremity motor function facilitated patient mobilization.
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