A Case Report: Adductor Canal Block and Popliteal Sciatic Nerve Block for Below Knee Amputation Surgery in Congestive Heart Failure patient

Abstract

Purpose : The objectives were to evaluate the use of combined popliteal sciatic nerve block and adductor canal block as sole anesthetic technique in congestive heart failure patient undergoing urgent below knee amputation (BKA) surgery and its clinical outcomes.

Study  design : Case study

Materials and Methods : A-married 56-year-old male, American Society of Anesthesiologists (ASA) Grade III, history of hypertension and dyslipidemia, follow up treatment at Ban Mo hospital (community hospital). The patient developed chronic osteomyelitis with sepsis, was treated with appropriate antibiotics and scheduled to undergo urgent BKA surgery by Orthopedic Surgeon. Furthermore, patient was diagnosed with congestive heart failure. The anesthetic technique was combined 2-sites peripheral nerve block; Popliteal nerve anesthesia by popliteal sciatic nerve block and Saphenous nerve anesthesia by adductor canal block.

Main findings : The patients requiring emergency or urgent below knee amputation usually present with osteomyelitis, sepsis, and critical illness. Administration of spinal anesthesia or general anesthesia is usually associated with adverse hemodynamic effects and high perioperative mortality. Combined adductor canal block and popliteal sciatic nerve block under ultrasound guidance is quite uncommon which provides safe and adequate postoperative pain controlling alternative anesthetic technique for such patients. Case report of patient with congestive heart failure use popliteal sciatic nerve block and adductor canal block as a sole anesthesia for urgent below knee amputation surgery.

Conclusion and recommendations : This study shows that combined popliteal sciatic nerve block and adductor canal block is a viable option for reliable anesthesia for urgent below knee amputation surgery which provides safe and adequate postoperative pain controlling and stable hemodynamic status. It’s especially preferable for severe illness or high risk patients that administration of central neuraxial block or general anaesthesia is usually associated with adverse hemodynamic effects.