P318 Sciatic catheter placed under direct vision. A case report

<h3></h3> <b>Application for ESRA Abstract Prizes:</b> <h3>Background and Aims</h3> Oncologic surgery of the musculoskeletal system is frequently aggressive and associated with significant postoperative pain. These procedures often involve atypical tumor locations, which may necessitate unusual surgical approaches. As a result, the placement of peripheral nerve catheters can be limited, particularly when the standard insertion site lies within the surgical field. Alternative strategies must be considered to ensure adequate analgesia in the postoperative period. <h3>Methods</h3> We present the case of an 18-year-old male who underwent an en bloc resection of a peroneal Ewing’s sarcoma involving both bone and adjacent soft tissues. The surgical incision extended across the lower third of the lateral compartment of the leg, precluding the standard placement of a popliteal nerve catheter. Additionally, the patient’s anatomy presented challenges to more proximal catheter placement using conventional ultrasound-guided techniques. To overcome these limitations, the surgical team opted for intraoperative placement of a peripheral nerve catheter under direct vision prior to wound closure. This approach ensured accurate positioning while avoiding contamination of the surgical field. <h3>Results</h3> The patient retained the catheter for seven days postoperatively, during which he experienced excellent pain control (Visual Analog Scale &lt;3), with only one transient episode of higher pain (VAS 6) that responded to a morphine bolus. No complications related to the catheter were observed. The patient was discharged on postoperative day 10 without incident. <h3>Conclusions</h3> In conclusion, we suggest that intraoperative placement of peripheral nerve catheters by the surgical team may be a safe and effective alternative when standard approaches are contraindicated or technically challenging.