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Continuous Thoracocervical Epidural Analgesia for Management of Perioperative Pain in an Adolescent with OsteosarcomaA Case Report
Jack M. Berger, MD, PhD1; Raymond G. Tatevossian, MD1; James H. Daniel, MD1; Sina Samie, BA1
1 Department of Anesthesiology, University of Southern California, 1200 N. State Street, Room C4E100, Los Angeles, CA 90033. E-mail address for S. Samie: ssamie@slu.edu
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Investigation performed at the Department of Anesthesiology, University of Southern California, Los Angeles, California



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 Mar 27;3(1):e26 1-2. doi: 10.2106/JBJS.CC.L.00257
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Extract

Osteosarcoma, an aggressive spindle-cell neoplasm, is the most common bone malignancy in children and young adults, with an incidence of 1 in 100,000 persons1. The presenting symptoms are pain and swelling of the affected extremity. The cause of pain is twofold: mass effect limiting motion and direct nerve involvement of the proximal neurovascular bundles. Osteosarcoma causes complex unrelenting pain, resulting in high opioid requirements. Because the treatment of osteosarcoma is neoadjuvant chemotherapy and resection, it is understandable that adequate pain control is an integral component of the multidisciplinary care required by these patients.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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