Question of the Month – May 2018 - Society for Pediatric Pain Medicine

17 year old male with Ewing sarcoma of Left 7th rib with bilateral pulmonary metastases scheduled for chest wall resection (en bloc with 6th, 7th, and 8th ribs together with diaphragm and left lower pulmonary lobe), left upper lobe and left lower lobe pulmonary wedge resections.
PMH: pneumonia 2 months ago -resolved. Otherwise unremarkable.
Preop labs -
Hemoglobin: 10.3 (L)
Hematocrit: 30.9 (L)
Platelet Count: 193
Fibrinogen: 338
INR: 1.0
Part Thromboplastin: 59.8 (H)
Prothrombin Time: 13.4

The anesthesia team in the room has tried placing an awake thoracic epidural
without success. You are called to suggest options for pain management.

What postoperative pain management options would you then choose?

1. PCA only

2. Thoracic epidural catheter under GA

3. Paravertebral catheter with PCA supplement

4. Erector spinae plane block with PCA supplement

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Question of the Month – May 2018

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