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Background and Aims Background: Severe pain from sacral fractures can be difficult to treat especially in the parturient where systemic analgesia options are limited by its maternal and fetal side effects. Regional anaesthesia can be especially useful in providing analgesia due to its minimal side effects. Aims: We postulated that a sacral plexus catheter can help achieve our goals of 1) long-lasting pain control without need for repeated procedures, 2) minimal maternal and fetal side effects, 3) facilitating physiotherapy and rehabilitation, and 4) early home discharge.
Methods We detail the case of a 30-year-old 16-week parturient with traumatic sacral fractures. Despite optimal multimodal analgesia, our patient experienced debilitating pain affecting her breathing, sleep, and rehabilitation. As analgesia options were limited, regional anaesthesia techniques including a sacral plexus catheter, caudal and lumbar epidural block were offered. A right sacral plexus catheter was eventually inserted for pain relief, using the parasacral parallel shift approach under ultrasound guidance. An initial local anaesthetic bolus of 15mL Lignocaine 1.5% with adrenaline 1:200,000 was injected, followed by a continuous infusion of Ropivacaine 0.2% at 5ml/h. She was followed up daily by the Acute Pain Service team.
Results With the sacral plexus catheter, our patient experienced significant pain relief and rehabilitated well. She reported improvement in pain with from a Numeric Rating Scale of 10 to 2 post-procedure and recovered sufficient function for home within 1 week.
Conclusions We conclude that a sacral plexus catheter is a good viable option in providing analgesia and facilitating rehabilitation in the parturient with traumatic sacral fractures.
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