Pelvic and Sacral Resections and Fractures

Background

Major bony resections of the sacrum or pelvis are performed as primary treatment of usually cancerous bone tumors. Major pelvic surgery is also done for repair of complicated pelvic or acetabular fractures. As in major spinal or hip surgery, care in positioning for a long procedure is important, because many of these operations are done in the lateral or prone positions (see Table 61-3 ).

Anesthetic Management

Measures for conservation of blood resources and body heat should be carefully followed (see Chapter 40 , Chapter 47 , and Chapter 48 ). Invasive monitoring may be essential, and improved postoperative analgesia by means of epidural catheters should be strongly considered^[150] (see Table 61-5 ).

If the dissection will involve major pelvic vasculature or nerve roots, the following additional measures may be taken. Pulse oximetry in the lower extremity (toe) can aid in judging adequacy of circulation, and SSEP monitoring of L4-5 to S2 nerve roots may help to lessen the possibility of nerve damage during en bloc dissections of the sacrum (see Table 61-5 ) or during repair of pelvic fractures. If SSEP monitoring is used, epidural anesthesia and inhalation anesthetics may be contraindicated. Additional large-bore intravenous cannulas may be needed in anticipation of rapid fluid and blood infusion during major resections.