MANAGING COMPLICATIONS IN PEDIATRIC EWING'S SARCOMA: PAIN CONTROL AND WOUND INFECTION FOLLOWING KNEE DISARTICULATION CASE REPORT

INTRODUCTION

• Ewing’s Sarcoma Overview: A rare, aggressive bone cancer mostly seen in children, requiring chemotherapy, surgery, and radiotherapy.
• Pain Management Challenge: Conventional analgesics often fail to provide adequate relief, particularly after major limb surgeries like knee disarticulation.

CASE STUDY

• Patient Profile: 5-year-old male, Ewing’s Sarcoma in the left knee, underwent knee disarticulation.
• Initial Analgesic Approach: Gabapentin, amitriptyline, and morphine were ineffective against severe neuropathic pain.
• Innovative Solution: Introduction of ultrasound-guided sciatic and femoral nerve blocks with clonidine and dexamethasone, leading to:
  • Significant pain reduction
  • Decreased opioid use
  • Elimination of phantom limb sensations

RESULTS

• Improved Outcomes: Enhanced analgesia and comfort post-surgery, with minimal opioid requirements.
• Behavioral Improvements: Reduced FLACC scale scores indicating decreased pain and distress.

DISCUSSION

• Importance of Multimodal Strategies: Tailored approaches, including regional anesthesia, are critical for effective pain management in pediatric oncology.
• Potential Long-term Benefits: Regional anesthesia may help prevent chronic postsurgical pain by reducing central sensitization.

CONCLUSION

• Promising Findings: Regional anesthesia is a valuable adjunct in pediatric oncologic surgeries, warranting further research to optimize protocols.

REFERENCES

• Wang JL, et al. Anesthesia and perioperative management for giant adrenal Ewing's sarcoma. World J Clin Cases. 2022.
• Morais D, et al. Continuous ESP block for Ewing’ sarcoma excision. Reg Anesth Pain Med. 2023.
• Choi S, et al. Effects of Dexamethasone on Sensory Block Duration. Can J Anaesth. 2014.