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B245 Coprehensive short-term metastatic hip lesion pain management with epidural analgesia and continuous posterior lumbar plexus (psoas compartement) and sciatic nerve blocks during radiotherapy: case report
  1. C Orfanou1,
  2. A Tsaroucha1,
  3. C Magklari2,
  4. I Koutalas1,
  5. A Tympa1 and
  6. N Fyrfiris2
  1. 1First Department of Anesthesiology and Pain Unit Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
  2. 2Agios Savvas, Anticancer – Oncological hospital of Athens, Athens, Greece


Background and Aims A 49-years-old female patient presented at the Pain Clinic suffering metastatic hip bone cancer, after being diagnosed with breast cancer. She had undergone left mastectomy, radiotherapy and chemotherapy, before ending up with persistent right hip pain (NPRS 10), that initially was wrongfully attributed to her congenital hip dislocation. Radiotherapists requested relevant pain management, in order to achieve the appropriate lower limb position required for the radiotherapy.

Methods After a successful trial of posterior lumbar plexus (psoas compartment) block, that led to complete pain management, an unsuccessful placement of a percutaneous catheter of continuous infusion was attempted. Subsequently, an epidural catheter was placed at O2-O3 level and a test dose was administered uneventfully. Nevertheless, the patient’s reaction to the first full ropivacaine dose suggested that a potential dural puncture had taken place, followed by spinal influx of the local anesthetic. That was also later confirmed by patient’s manifestations and presence of air in the brain ventricles as depicted at the brain CT. Finally, the placement of a catheter of continuous infusion at the posterior lumbar plexus (psoas compartment) was achieved. After complaints of increasing neuropathic pain at the thighs’ posterior surface, a second continuous infusion catheter was placed at the sciatic nerve. Both catheters were connected to 0.2% ropivacaine pumps.

Results Metastatic hip bone radiotherapy was achieved under complete analgesia (NPRS 0) of the local metastatic cancer pain.

Conclusions This case illustrates that complete short-term pain management of metastatic hip lesion is feasible through well-targeted pain management strategies.

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