Abstract
Recent cadaver studies have suggested that posterior femoral cutaneous nerve (PFCN) may contribute to the sensory innervation of the posterior lower leg. Whether this is clinically relevant may be revealed in patients who underwent below-the-knee amputation (BKA) with monitored anesthesia care (MAC) and peripheral nerve blocks. We performed femoral and sciatic nerve blocks for a 55-year-old male patient who underwent BKA and subsequent formalization surgeries as the main surgical analgesia while providing MAC in the operating room. In both cases, the patient could not tolerate surgical incisions in the posteromedial aspect of the lower leg, despite reporting no pain in other areas of the lower leg with surgical stimulation. There may exist a small population of patients in which PFCN makes significant contribution to the sensory innervation of the posterior lower leg. For these patients, the combination of femoral and sciatic nerve blocks may not be adequate in providing surgical analgesia for BKA and related procedures.
Highlights
Lower extremity amputation is one of the most common vascular surgeries performed in the United States [1]
Regional anesthesia technique is frequently used for lower extremity amputation as it has been shown to be associated with reduced postprocedural pain and short-term need for opiate medications, shorter postanesthesia care unit (PACU) stay, and decreased postoperative cardiopulmonary complications when compared with general anesthesia [2,3,4]
The posterior femoral cutaneous nerve (PFCN), which arises from S1-S3 of the sacral plexus and passes through the gluteal region alongside the sciatic nerve, has been recognized conventionally as a nerve that provides sensory innervation to the perineum and posterior thigh to the level of the popliteal fossa
Summary
Lower extremity amputation is one of the most common vascular surgeries performed in the United States [1]. We present a case in which a combination of femoral and sciatic nerve blocks failed to provide adequate surgical analgesia in the posterior lower leg region for a patient who underwent below-the-knee amputation (BKA) and subsequent formalization surgery. This case may serve as a springboard to investigate the need of performing a PFCN block to improve the analgesia coverage and prevent inadequate blocks for BKA surgeries when inadequate analgesia is initially noted. The On-Q pump catheter was discontinued five days later when the patient was discharged to a physical rehabilitation facility
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