Major Pelvic Ortho-oncological Surgeries

Abstract

Background and Aims: Anaesthesia for pelvic tumour surgeries is challenging because of major blood loss, extensive tissue damage, hypothermia due to the longer duration of surgery, unusual and frequent change in positions, ongoing postoperative blood loss and post-operative pain management. This retrospective study aimed to assess the perioperative anaesthetic management for patients undergoing major pelvic tumour surgeries in our institute. Methods: We collected data from 20 patients from the patient files, anaesthesia records and electronic medical records about demographics, type and duration of surgery, pre-operative morbidities, preoperative chemotherapy/radiotherapy, intraoperative anaesthesia management with respect to fluids, blood loss, blood products transfused and postoperative pain management and complications. Data were summarised using percentages for categorical data and medians for continuous data. Results: Sixteen patients were given epidural and general anaesthesia, while four were given only general anaesthesia. The median duration of surgery was 7 h (interquartile range [IQR] 5–10 h). Multiple surgeons were involved in four cases. The median blood loss was 1500 ml (IQR 550–2750 mL); nine patients needed massive blood transfusions. Navigation-guided surgical cuts were made in eight patients. Three required postoperative mechanical ventilation. The pain was managed by epidural infusions and intravenous patient-controlled fentanyl infusions. The postoperative complication was seen in two patients in the form of wound infection and a post-operative bleed. Conclusion: The major pelvic orthopaedic oncological surgeries require meticulous attention to patient-centric perioperative care. A dedicated team approach with a definitive surgical plan, anticipating complications and their timely intervention, pain management and postoperative rehabilitation can lead to improved outcomes.