title: Thoracic epidural analgesia to control malignant pain until viability in a pregnant patient.
abstract: Management of nonobstetric pain in the pregnant patient presents unique challenges related to transplacental fetal exposure to opioids and the subsequent risk of neonatal withdrawal syndrome. We present the case of a pregnant patient suffering from the pain of a progressively enlarging thoracoabdominal sarcoma. Epidural analgesia (using local anesthetics with minimal opioid) was utilized over a span of weeks to manage oncologic pain, limiting fetal opioid exposure and culminating in the birth of a healthy infant. While nonobstetric abdominal pain during pregnancy is not that uncommon, neoplastic abdominal pain does appear to be rare. Combined local anesthetic and opioid continuous epidural infusion should be considered a viable option in the pain management approach to obstetric patients with nonobstetric pain associated with malignancy.
authors.affiliation: Department of Anesthesiology, UT Health, McGovern Medical School, Houston, TX, USA.
authors.forename: Jaideep H
authors.initials: JH
authors.lastname: Mehta
authors.affiliation: Orlando Health, Orlando, FL, USA.
authors.forename: Mary Elizabeth
authors.initials: ME
authors.lastname: Gibson
authors.affiliation: UT Health, McGovern Medical School, Houston, TX, USA.
authors.forename: David
authors.initials: D
authors.lastname: Amaro-Driedger
authors.affiliation: Department of Anesthesiology, UT Health, McGovern Medical School, Houston, TX, USA.
authors.forename: Mahammad N
authors.initials: MN
authors.lastname: Hussain
keywords: epidural; malignant; pregnancy; sarcoma