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Introduction: A worrying increase in the number of bone tumors that appear at younger ages justifies the efforts aimed at optimizing perioperative management practices in orthopedic tumor surgery. Pain control is critical in the prognosis and postoperative outcome of these procedures.
Material and methods: Our study included a group of 11 patients diagnosed with bone malignancies. These patients were hospitalized in the Orthopedic Clinic of the University Emergency Hospital Bucharest. Under our supervision, they underwent surgical treatment of the tumor under combined general anesthesia and epidural anesthesia for the pelvic limb, and general anesthesia only for the upper limb. We performed perioperative pain management with multimodal analgesia (continuous epidural analgesia with ropivacaine 0,2% and fentanyl 2 mcg/ml in association with systemic analgesics). Following this procedure, we measured the intensity of the postoperative pain at intervals of 48 hours and one week after surgery and compared with preoperative pain intensity using the visual analogue pain scale (VAS).
Results: Multimodal analgesia (epidural analgesia associated with systemic analgesics – paracetamol, COX2 inhibitor, gabapentinoids) was performed well in the postoperative pain of the tumor prosthesis, with a significant decrease in VAS from a mean value of 7.63 preoperatively to an average of 3 in the first 48 hours postoperatively. After the removal of the epidural catheter, which also coincided with patient mobilization, the level of pain registered a slight increase to a mean value of 3.23.
Conclusions: Multimodal analgesia is currently considered the gold standard in perioperative pain management. The use of multimodal analgesia during perioperative period in patients with bone tumors has been shown to decrease the length of hospital stay, improve surgical outcome, reduce the number of systemic complications, and improve the long-term prognosis of the patient. Efficacy of analgesia correlates with tumor site and vascularization.
</abstract>

Introduction: A worrying increase in the number of bone tumors that appear at younger ages justifies the efforts aimed at optimizing perioperative management practices in orthopedic tumor surgery. Pain control is critical in the prognosis and postoperative outcome of these procedures.
Material and methods: Our study included a group of 11 patients diagnosed with bone malignancies. These patients were hospitalized in the Orthopedic Clinic of the University Emergency Hospital Bucharest. Under our supervision, they underwent surgical treatment of the tumor under combined general anesthesia and epidural anesthesia for the pelvic limb, and general anesthesia only for the upper limb. We performed perioperative pain management with multimodal analgesia (continuous epidural analgesia with ropivacaine 0,2% and fentanyl 2 mcg/ml in association with systemic analgesics). Following this procedure, we measured the intensity of the postoperative pain at intervals of 48 hours and one week after surgery and compared with preoperative pain intensity using the visual analogue pain scale (VAS).
Results: Multimodal analgesia (epidural analgesia associated with systemic analgesics – paracetamol, COX2 inhibitor, gabapentinoids) was performed well in the postoperative pain of the tumor prosthesis, with a significant decrease in VAS from a mean value of 7.63 preoperatively to an average of 3 in the first 48 hours postoperatively. After the removal of the epidural catheter, which also coincided with patient mobilization, the level of pain registered a slight increase to a mean value of 3.23.
Conclusions: Multimodal analgesia is currently considered the gold standard in perioperative pain management. The use of multimodal analgesia during perioperative period in patients with bone tumors has been shown to decrease the length of hospital stay, improve surgical outcome, reduce the number of systemic complications, and improve the long-term prognosis of the patient. Efficacy of analgesia correlates with tumor site and vascularization.

Multimodal analgesia in primary bone tumors

“Carol Davila” University of Medicine and Pharmacy

Romanian Journal of Orthopaedic Surgery and Traumatology

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

{"article-title":"Multimodal analgesia in primary bone tumors"}

Introduction: A worrying increase in the number of bone tumors that appear at younger ages justifies the efforts aimed at optimizing perioperative management...

Multimodal analgesia in primary bone tumors

Publicado en línea: 13 ago 2021

Páginas: 30 - 37

Aceptado: 22 jul 2021

DOI: https://doi.org/10.2478/rojost-2021-0006

Palabras clave
epidural analgesia, bone malignancies, pain, outcome

© 2021 Angelica Bratu et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Multimodal analgesia in primary bone tumors

Publicado en línea: 13 ago 2021

Páginas: 30 - 37

Aceptado: 22 jul 2021

DOI: https://doi.org/10.2478/rojost-2021-0006

Palabras claveepidural analgesia, bone malignancies, pain, outcome

© 2021 Angelica Bratu et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Palabras clave
epidural analgesia, bone malignancies, pain, outcome