Post-Operative Epidural Analgesia For Radical Nephrectomy With IVC Thrombectomy

Proposal Number:

MCC-7135 

Proposal Type:

Medically Challenging Case Report Poster 

Author:

Allison Michaeli  
Westchester Medical Center

Co-Author:

Jian Hou  
Westchester Medical Center

Abstract:

Nephrectomy with thrombectomy can be curative for patients with renal cell carcinoma (RCC) extending into the inferior vena cava (IVC) [1]. Although case reports exist on anesthetic management of these patients, none report thoracic epidural placement.

Case Report: A 61-year-old male with a history of RCC with IVC extension presented for a right radical nephrectomy with thrombectomy. Pre-operatively, a thoracic epidural catheter was placed. Following nephrectomy, hemorrhage occurred. Hemodynamic stability was regained with massive transfusion protocol and vasopressors. Post-operative pain was well-controlled with a ropivicaine 0.2% infusion through his epidural catheter.

Morita et al. reported epidural analgesia was avoided due to coagulopathy risk [1]. In our case, platelet count was checked and guidelines were followed, resulting in no complications. Furthermore, continuous epidural analgesia is associated with a significant reduction in chronic post-surgical pain [2]. In conclusion, this case is an example of successful epidural analgesia for nephrectomy with IVC thrombectomy.

Professional Category:

Resident/Trainee

Keywords:

Pain Management
Regional

Enter up to two references.

  Reference
1. Morita Y, Ayabe K, Nurok M, Young J. Perioperative anesthetic management for renal cell carcinoma with vena caval thrombus extending into the right atrium: case series. J Clinical Anesthesia. 2017; 36: 39-46.
2. Bouman EA, Theunissen M, Bons SA, et al. Reduced incidence of chronic postsurgical pain after epidural analgesia for abdominal surgery. Pain practice. 2014; 14:76-84.