We report three cases of children with osteosarcoma and pathologic fractures treated with long-term continuous nerve blocks for preoperative pain control.
One patient with a left distal femoral diaphysis fracture had a femoral continuous nerve block catheter for 41 days without complications. Another with a fractured left proximal femoral shaft had three femoral continuous nerve block catheters for 33, 26 and 22 days respectively. The third patient, whose right proximal humerus was fractured, had a brachial plexus continuous nerve block catheter for 36 days without complication.
In our experience, prolonged use of continuous nerve block is safe and effective in children with pathologic fractures for preoperative pain control.
BielackS., CarrleD., CasaliP.G.Osteosarcoma: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol2009; 20: 137–139.
2.
PapagelopoulosP.J., MavrogenisA.F., SavvidouO.D., BenetosI.S., GalanisE.C., SoucacosP.N.Pathological fractures in primary bone sarcomas. Injury2008; 39: 395–403.
3.
BacciG., FerrariS., LonghiA., DonatiD., ManfriniM., GiacominiS.Nonmetastatic osteosarcoma of the extremity with pathologic fracture at presentation: local and systemic control by amputation or limb salvage after preoperative chemotherapy. Acta Orthop Scand2003; 74: 449–454.
4.
BramerJ.A., AbuduA.A., GrimerR.J., CarterS.R., TillmanR.M.Do pathological fractures influence survival and local recurrence rate in bony sarcomas?Eur J Cancer2007; 43: 1944–1951.
5.
PacentaH.L., KaddoumR.N., PereirasL.A., ChidiacE.J., BurgoyneL.L.Continuous tunnelled femoral nerve block for palliative care of a patient with metastatic osteosarcoma. Anaesth Intensive Care2010; 38: 563–565.
6.
MiguelR.Interventional treatment of cancer pain: the fourth step in the World Health Organization analgesic ladder?Cancer Control2000; 7: 149–156.
7.
LonnqvistP.A., MortonN.S.Postoperative analgesia in infants and children. Br J Anaesth2005; 95: 59–68.
8.
LudotH., BergerJ., PichenotV., BelouadahM., MadiK., MalinovskyJ.M.Continuous peripheral nerve block for postoperative pain control at home: a prospective feasibility study in children. Reg Anesth Pain Med2008; 33: 52–56.
9.
IlfeldB.M., EnnekingF.K.Continuous peripheral nerve blocks at home: a review. Anesth Analg2005; 100: 1822–1833.
10.
GaneshA., RoseJ.B., WellsL., GanleyT., GurnaneyH., MaxwellL.G.Continuous peripheral nerve blockade for inpatient and outpatient postoperative analgesia in children. Anesth Analg2007; 105: 1234–1242, table of contents.
11.
DadureC., BringuierS., RauxO., RochetteA., TroncinR., CanaudN.Continuous peripheral nerve blocks for postoperative analgesia in children: feasibility and side effects in a cohort study of 339 catheters. Can J Anesth2009; 56: 843–850.
12.
StewartB., Tudur SmithC., TeebayL., CunliffeM., LowB.Emergency department use of a continuous femoral nerve block for pain relief for fractured femur in children. Emerg Med J2007; 24: 113–114.
13.
DangelT.Chronic pain management in children. Part II: Reflex sympathetic dystrophy. Paediatr Anaesth1998; 8: 105–112.
14.
AnghelescuD.L., FaughnanL.G., BakerJ.N., YangJ., KaneJ.R.Use of epidural and peripheral nerve blocks at the end of life in children and young adults with cancer: the collaboration between a pain service and a palliative care service. Paediatr Anaesth2010; 20: 1070–1077.
CapdevilaX., PiratP., BringuierS., GaertnerE., SingelynF., BernardN.Continuous peripheral nerve blocks in hospital wards after orthopedic surgery: a multicenter prospective analysis of the quality of postoperative analgesia and complications in 1,416 patients. Anesthesiology2005; 103: 1035–1045.
17.
NeuburgerM., ButtnerJ., BlumenthalS., BreitbarthJ., BorgeatA.Inflammation and infection complications of 2285 perineural catheters: a prospective study. Acta Anaesthesiol Scand2007; 51: 108–114.
18.
CompereV., LegrandJ.F., GuitardP.G., AzougaghK., BaertO., OuennichA.Bacterial colonization after tunneling in 402 perineural catheters: a prospective study. Anesth Analg2009; 108: 1326–1330.
