These cases are well worth discussing with the surgeon beforehand- the anticipated potential for blood loss, and the incision used to remove the tumour varies.
Pre-op
- Discuss with surgeon:
- Size of planned incision (spinal for larger incisions)
- Location of tumour – (if near large vessels, then consider art line, cross match, cell salvage. There can be rapid blood loss)
Peri-op
- 20G cannula
- Spinal – 2ml heavy 0.5% L-bupivicaine + 500mcg diamorphine (2.5ml total volume)
- Processed EEG monitoring
- Induction
- Propofol/ remi TIVA
- Muscle relaxant
- ETT
- 16G cannula – ideally on uppermost limb
- Arterial line (if tumour near large vessels, or patient indications)
- Lateral, table broken (expect hypotension when table folds)
- Keep still with remi or muscle relaxant
- Magnesium 3g
- Dexamethasone 6.6mg
- TAP blocks by surgeons at end
- If no spinal- load with long acting opiate
Post-op
- BD modified release oral morphine with PRN oral morphine
- Regular paracetamol
Anaesthetic Recipes 
Is the reasoning behind giving magnesium for analgesia in view of the long/painful procedure, or something else?
Great website btw!
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Hello Dan, thank you! That’s exactly right- it’s a useful analgesic
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An aside – any thoughts on opioid-only spinals?
I have seen 300mcg PF morphine/300-400mcg diamorphine made up to desisted volume in saline given for nephrectomies & other procedures but haven’t found a lot of info/evidence about this practice
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Interesting! I’ve heard of it, but never seen it done. How have they been? What was the reasoning?
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Ostensibly to avoid/reduce the fall in SVR and haemodynamic instability with LA, e.g. with frail ASA3 patients. Not entirely convinced myself, might just be dogma of local practice. Anecdotally (albeit pretty small sample) seems to provide pretty decent post-op analgesia
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