Epidural analgesia in patients with thrombocytopenia. Clinical case

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Abstract

The article presents a clinical case of a 25-year-old patient with progressive diffuse B-cell lymphoma with lesions of the S2 nerve root, accompanied by pain syndrome that is not relieved by systemic multimodal analgesia using opioids, antiepileptic and non-steroidal anti-inflammatory drugs. Polyneuropathy, secondary immunodeficiency, thrombocytopenia grade IV refractory to platelet concentrate transfusion, Guillain-Barre syndrome, impaired the somatic status and intensified the pain syndrome. Local anesthetics epidural port was successfully implanted to improve quality of analgesia. As a result of prolonged epidural infusion of 0.2% ropivacaine with titration rate from 4 to 7 ml/hour depending on the severity of the pain syndrome, that significantly improved patient’s quality of life was achieved by reducing the intensity of pain and increasing duration of night sleep. In the early postoperative and long-term follow-up periods (14 days), there were no hemorrhagic and infectious complications associated with the use of the epidural port.

About the authors

E. V. Goncharova

Raisa Gorbacheva Memorial Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov First Saint-Petersburg State Medical University; Valdman Institute of Pharmacology, Pavlov First Saint-Petersburg State Medical University

Author for correspondence.
Email: ek.v.goncharova@gmail.com
ORCID iD: 0000-0003-4789-7460

MD, anesthesiologist

Russian Federation, Saint Petersburg

A. Y. Polushin

Raisa Gorbacheva Memorial Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov First Saint-Petersburg State Medical University

Email: ek.v.goncharova@gmail.com
ORCID iD: 0000-0001-8699-2482
Russian Federation, Saint Petersburg

M. A. Kucher

Raisa Gorbacheva Memorial Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov First Saint-Petersburg State Medical University

Email: ek.v.goncharova@gmail.com
ORCID iD: 0000-0001-6114-3214
Russian Federation, Saint Petersburg

M. V. Ermolova

Raisa Gorbacheva Memorial Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov First Saint-Petersburg State Medical University

Email: ek.v.goncharova@gmail.com
ORCID iD: 0000-0002-1630-7221
Russian Federation, Saint Petersburg

Y. R. Zalyalov

Raisa Gorbacheva Memorial Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov First Saint-Petersburg State Medical University

Email: ek.v.goncharova@gmail.com
ORCID iD: 0000-0002-3881-4486
Russian Federation, Saint Petersburg

I. V. Portnyagin

Raisa Gorbacheva Memorial Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov First Saint-Petersburg State Medical University

Email: ek.v.goncharova@gmail.com
ORCID iD: 0000-0003-4720-0213
Russian Federation, Saint Petersburg

M. P. Bogomolny

Raisa Gorbacheva Memorial Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov First Saint-Petersburg State Medical University

Email: ek.v.goncharova@gmail.com
ORCID iD: 0000-0001-5721-3259
Russian Federation, Saint Petersburg

A. Y. Sokolov

Valdman Institute of Pharmacology, Pavlov First Saint-Petersburg State Medical University; Pavlov Institute of Physiology of the Russian Academy of Sciences

Email: ek.v.goncharova@gmail.com
ORCID iD: 0000-0002-6141-486X
Russian Federation, Saint Petersburg

G. E. Ulrikh

Saint Petersburg State Pediatric Medical University

Email: ek.v.goncharova@gmail.com
ORCID iD: 0000-0001-7491-4153
Russian Federation, Saint Petersburg

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2. S2 root lesion. According to MRI (modeT1) there is a local thickening of the root 1.1 × 1.3 cm in the sacral canal with widening of sacral foramen and active contrast accumulation and rapid «washing out»

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