Article Text
PDF
Abstract
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)
Background and Aims This presentation delineates the case of a 68-year-old female diagnosed with a substantial chondrosarcoma (8x12cm) involving both the left sacroiliac joint and L4-L5 left laminae. Surgical intervention entailed en bloc resection encompassing the left sacroiliac joint and L4-L5 hemilaminectomy, accompanied by osseal reconstruction and L3-L5 bilateral arthrodesis to achieve articular stabilization. General anesthesia was administered with the patient in the prone position along with lumbar epidural catheterization at L1-L2. However, due to the extensive surgical incision, removal of the epidural catheter was necessitated. Prior to removal, 4mg of epidural morphine were administered. Subsequently, a new epidural catheter was inserted at the L1-L2 level under fluoroscopic guidance to ensure positioning above the arthrodesis site. Postoperatively, the patient was expeditiously extubated with gradual discontinuation of vasoactive agents, experiencing pain-free convalescence facilitated by a ropivacaine 0.2% epidural infusion (4 ml/h).
Results Bone sarcomas, characterized by their substantial size and local invasiveness, demand comprehensive expertise in locoregional anesthesia. However, the applicability of locoregional techniques may be constrained by the tumor’s extent. Although typically utilized in Pain Clinics, fluoroscopy serves as a valuable modality for guiding epidural catheter insertion, ensuring heightened precision and safety. Particularly in scenarios where surgical maneuvers may impede catheter insertion, fluoroscopic guidance emerges as an indispensable adjunct to secure optimal positioning, particularly in patients positioned prone.
Conclusions In challenging catheterization scenarios, particularly within instrumented spines, fluoroscopy-guided techniques offer a pragmatic approach to ensure the safe and efficacious placement of epidural catheters.
Contrast diffusion in the epidural space