Abstract
BackgroundAnesthetic management of lower extremity amputation in chronic hemodialysis (HD) patients can be challenging because of their poor cardiovascular status. As previously reported, peripheral nerve block (PNB) may be beneficial in these complicated cases. We report the effects of PNB combined with general anesthesia on hemodynamic stability in HD patients undergoing elective lower extremity amputation.MethodsWe retrospectively analyzed 13 HD patients who underwent lower extremity amputation. Patients received general anesthesia (GA group, n = 7) or general anesthesia combined with PNB (GA with PNB group, n = 6), as decided by the anesthesiologists. Mean blood pressure (MBP), systolic blood pressure (SBP), lowest BP, heart rate (HR), blood loss, fluid and blood infusion volumes, and doses of vasopressors required were compared for hemodynamic assessment. The coefficient of variation ( mathrm{CV}=upsigma /overline{mathcal{X}} ) of MBP (CVMBP) and SBP (CVSBP) was calculated to compare hemodynamic stability. Intraoperative opioid use and postoperative pain scores at rest using a numerical rating scale (NRS) on postoperative days 0 and 1 were compared for pain assessment. We also assessed 30-day mortality.ResultsCVMBP in the GA group was significantly higher than that in the GA with PNB group (0.15 ± 0.05 and 0.08 ± 0.04, respectively, p = 0.03). The CVSBP in the GA group was also significantly higher than that in the GA with PNB group (0.16 ± 0.02 and 0.09 ± 0.01, respectively, p = 0.03). No significant differences in other hemodynamic parameters were observed. Intraoperative fentanyl doses were significantly lower in the GA with PNB group (GA 210.7 ± 99.9 μg vs. GA with PNB 113.0 ± 75.6 μg, p = 0.04). There were no significant differences in other pain parameters and 30-day mortality between the groups.ConclusionOur results suggest that PNB combined with general anesthesia contributes to intraoperative hemodynamic stability through better pain control in HD patients undergoing lower extremity amputation.
Highlights
Peripheral artery disease is recognized as a serious complication in patients requiring chronic hemodialysis (HD)
We retrospectively reviewed the cardiovascular status, including the coefficient of variation (CV) value of blood pressure, in HD patients during lower extremity amputation under general anesthesia with or without peripheral nerve block (PNB)
Inclusion criteria were HD patients undergoing elective lower extremity amputation under general anesthesia or general anesthesia combined with PNB
Summary
Peripheral artery disease is recognized as a serious complication in patients requiring chronic hemodialysis (HD). The anesthetic management of lower extremity amputation for critical limb ischemia, an advanced form of peripheral artery disease, in HD patients can be challenging because of their poor cardiovascular status, including blood pressure instability [1]. No study has described the relationship between anesthetic management with PNB and CV value of blood pressure. We retrospectively reviewed the cardiovascular status, including the CV value of blood pressure, in HD patients during lower extremity amputation under general anesthesia with or without PNB. Anesthetic management of lower extremity amputation in chronic hemodialysis (HD) patients can be challenging because of their poor cardiovascular status. We report the effects of PNB combined with general anesthesia on hemodynamic stability in HD patients undergoing elective lower extremity amputation
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