Nerve Stimulator Guided Lumbar Plexus and Parasacral Sciatic Nerve Block for above Knee Amputation in a High-Risk Patient: A Case Report

Cano Penafrancia Catangui

doi:10.36959/377/339

Abstract

Ultrasound guidance is the most widely used nerve localization method of choice for peripheral nerve blocks. It can provide direct visualization of the needle, nerves, and the spread of the local anesthetic improving the success rate. In contrast, nerve stimulation relies on surface landmark identification, and physiological responses of neural structures to electrical stimulation which can be highly influenced by injectates and physiologic solutions affecting its efficacy.

Highlights

It is imperative that an adequate preoperative evaluation and a rational intraoperative and postoperative anesthetic management of patients with diabetes be exercised to avoid morbidity and mortality
Perioperative mortality rate ranges from 2.8% to 35% for Above knee amputation (AKA) patients, which is even worse compared to below knee amputation (BKA) with a risk of 0.9% to 14.1% [25]
This paper reports the use of peripheral nerve block for a very ill, diabetic patient who was scheduled for above knee amputation

Summary

Introduction

It is imperative that an adequate preoperative evaluation and a rational intraoperative and postoperative anesthetic management of patients with diabetes be exercised to avoid morbidity and mortality. This paper reports the use of peripheral nerve block for a very ill, diabetic patient who was scheduled for above knee amputation. Based from the pre-operative evaluation, considering the myriad of problems, a peripheral nerve block (PNB) in the form of combined lumbar plexus (LP) and parasacral sciatic nerveblock (PSNB) which would provide a unilateral lower extremity anesthesia, was decided as the anesthetic of choice to prevent any untoward perioperative cardiac morbidity. Calf muscles, and plantar flexion of the foot were elicited at a depth of 7 cm with a current of 1.5 mA until it was lowered down to 0.5 mA with better positioning of the needle near the nerve. With the persistence of the same blood pressure taken upon arrival at the operating room, 5 mg of Nitroglycerin patch was placed on the left anterior chest wall before surgery commenced. The patient was comfortable and did not complain of any pain during the whole duration of the procedure which lasted for 2 hours and 30 minutes (Figure 4)

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Discussion

Conclusion