Acquired von Willebrand Disease in a Child With Wilms’ Tumor: Implications for Postoperative Regional Anesthesia

Habib Kedir, Dmitry Tumin, Giorgio Veneziano, Joseph D. Tobias


Regional anesthetic techniques including epidural anesthesia are a safe and effective method of providing postoperative analgesia while avoiding the potential adverse physiologic effects of systemic opioids. However, clinical scenarios or co-morbid conditions such as abnormal coagulation function may preclude the use of neuraxial analgesia. We present a 2-year-old boy who presented for nephrectomy due to Wilms’ tumor disease. Preoperative evaluation of coagulation function revealed an elevated partial thromboplastin related to acquired von Willebrand disease and therefore a wound catheter was used instead of epidural analgesia. Coagulation function guidelines for epidural anesthesia are reviewed and alternative techniques such as a wound catheter are discussed.

J Med Cases. 2018;9(10):345-347


Postoperative pain management; Pediatric anesthesia; Regional anesthesia; Wound catheter; Coagulation function; von Willebrand disease

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