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

Abstract

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.