●Hemipelvectomy surgery is typically done under general anesthesia with neuraxial for post-operative analgesia

●In a patient with contraindications to neuraxial, surgeon-placed PNCs are a great option

●51-year-old male with a 18cm osteosarcoma of the left hip complicated by pulmonary embolism on therapeutic enoxaparin

●Neuraxial and lumbar plexus catheter were contraindicated due to the therapeutic anticoagulation

●Surgical team secured two perineural catheters to the left femoral and sacral plexus epineurium with 6-0 prolene under direct visualization

●Postoperatively, APMS maintained the catheters with infusions of 0.2% ropivacaine at 8ml/hr, with patient-controlled boluses of 3mL every 30 minutes and an oral multimodal pain regimen

●Patient remained comfortable on an oral MMPR with minimal narcotic requirements

●Femoral nerve catheter was removed on POD 7

●Sacral plexus catheter was replaced during a washout on POD 7 and then removed 6 days later

●Surgical placement of PNCs is an older technique described for other major oncologic resection amputations,2-4

●In complex surgeries where traditional techniques like NA are impossible or contraindicated, surgeon-placed PNCs with coordinated anesthesiologist management can be an excellent alternative.

●This joint effort between anesthesia and surgical teams allowed for a comfortable, opioid-sparing recovery