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Background and Aims Pathological fractures in cancer patients cause severe pain that is difficult to control pharmacologically. Continuous regional nerve blocks play a definite role in controlling such pain. Continuous Femoral Nerve Block (cFNB) was described a safe and effective analgesic technique for hip fractures, especially in adult patients.
Methods A 7-year-old girl, weighing 23kg, ASA IV, with a palliative metastatic neuroblastoma and thrombocytopenia (71000 platelets) was scheduled for bilateral femoral neck fracture osteosynthesis at 2 different surgical timings, under the same anaesthesia technique. General anaesthesia was combined with ipsilateral cFNB performed under ultrasound guide, and a 9ml bolus of 0.2% ropivacaine was administered. Intraoperatively analgesia was completed with lidocaine (1mg/Kg), ketamine (0.3mg/Kg). Postoperatively a perfusion of 0.1% ropivacaine at 5ml/h was initiated and maintained until day 4 postoperative combined with acetaminophen (15ml/Kg) every 6 hours.
Results Surgery and anaesthesia were uneventful. In the postoperative period leading to hospital discharge (5 days later), the VAS at rest or movement remained low (0-1), and no rescue analgesia was needed. The child showed an extreme degree of satisfaction with the management of postoperative pain, and no complications with the cFNB were reported during the hospital stay.
Conclusions In the present case report, a Continuous FNB was found to be a safe and effective analgesic technique for the management of pain associated with pathological fractures in paediatric cancer patient with thrombocytopenia. Consequently, cFNB should also be considered for these patients also preoperatively, to ensure adequate pain management and improved overall patient experience.