Ultrasound-guided Peripheral Nerve Blocks Research Articles

The efficacy of truncal peripheral nerve block for laparoscopic gynecologic surgery

Objective: Laparoscopic gynecological surgeries are widely used in the treatment of uterine and ovarian diseases and has advantages in terms of postoperative early recovery and cosmetic sequelae over open abdominal surgery. However, postoperative pain is significant. We evaluated the efficacy of ultrasound-guided truncal peripheral nerve block, including rectus sheath and transversus abdominis block.

Ultrasound-guided peripheral forearm nerve block for digit fractures in a pediatric emergency department

Although ultrasound-guided peripheral nerve block (UGPNB) has recently been introduced into pediatric emergency departments (EDs), knowledge of its use is still limited among pediatric emergency physicians. Ultrasound-guided ulnar nerve block (UGUNB) is a form of peripheral nerve block available for controlling the pain caused by phalangeal injuries, but studies of its use in pediatric patients are still scarce. The aim of this case series was to describe the experience of UGUNB use for pediatric phalangeal fractures in a pediatric ED setting. In all the patients with phalangeal fractures, the ulnar nerve was successfully visualized using a hockey-stick type transducer. Approximately 0.1–0.2 mg/kg of 1% lidocaine was used as the nerve block. The procedure was effective for pain control, and fracture reduction was successfully performed without the need for rescue analgesia. This case series demonstrated that UGUNB has the potential to be a useful alternative to conventional pain management in pediatric fifth digit injuries.

Prehospital ultrasound-guided nerve blocks improve reduction-feasibility of dislocated extremity injuries compared to systemic analgesia. A randomized controlled trial.

BackgroundOut-of-hospital analgosedation in trauma patients is challenging for emergency physicians due to associated complications. We compared peripheral nerve block (PNB) with analgosedation (AS) as an analgetic approach for patients with isolated extremity injury, assuming that prehospital required medical interventions (e.g. reduction, splinting of dislocation injury) using PNB are less painful and more feasible compared to AS.MethodsThirty patients (aged 18 or older) were randomized to receive either ultrasound-guided PNB (10 mL prilocaine 1%, 10 mL ropivacaine 0.2%) or analgosedation (midazolam combined with s-ketamine or with fentanyl). Reduction-feasibility was classified (easy, intermediate, impossible) and pain scores were assessed using numeric rating scales (NRS 0–10).ResultsEighteen patients were included in the PNB-group and twelve in the AS-group; 15 and 9 patients, respectively, suffered dislocation injury. In the PNB-group, reduction was more feasible (easy: 80.0%, impossible: 20.0%) compared to the AS-group (easy: 22.2%, intermediate: 22.2%, impossible: 55.6%; p = 0.01). During medical interventions, 5.6% [1/18] of the PNB-patients and 58.3% [7/12] of the AS-patients experienced pain (p<0.01). Recorded pain scores were significantly lower in the PNB-group during prehospital medical intervention (median[IQR] NRS PNB: 0[0–0]) compared to the AS-group (6[0–8]; p<0.001) as well as on first day post presentation (NRS PNB: 1[0–5], AS: 5[5–7]; p = 0.050). All patients of the PNB-group would recommend their analgesic technique (AS: 50.0%, p<0.01).ConclusionsPrehospital ultrasound-guided PNB is rapidly performed in extremity injuries with high success. Compared to the commonly used AS in trauma patients, PNB significantly reduces pain intensity and severity.

Deliberate practice using validated metrics improves skill acquisition in performance of ultrasound-guided peripheral nerve block in a simulated setting

Study objectivesThe aim of this study was to compare the effects of deliberate vs. self-guided practices (both using validated metrics) on the acquisition of needling skills by novice learners. DesignRandomized Controlled Study. SettingSimulation lab, Department of Anesthesia, St.Vincent's Hospital, Dublin. SubjectsEighteen medical students. InterventionsStudents were assigned to either (i) deliberate practice (n = 10) or (ii) self-guided practice (n = 8) groups. After completion of a ‘learning phase’, subjects attempted to perform a predefined task, which entailed advancing a needle towards a target on a phantom gel under ultrasound guidance. Subsequently, all subjects practiced this task using predefined metrics. Only subjects in the deliberate practice group had an expert anesthesiologist during practice. Immediately after completing ‘practice phase’, all subjects attempted to perform the same task, and, on the following day, made two further attempts in succession. Two trained consultant anesthesiologists assessed a video of each performance independently using the pre-defined metrics. MeasurementsNumber of procedural steps completed and number of errors made. Main resultsCompared with novices who self-guided their practice using metrics, those who undertook expert-supervised deliberate practice using metrics completed more steps (performance metrics) immediately after practice (median [range], 14.5 [12–15] vs. 3 [1–10], p < 0.0001) and 24 h later (15 [12–15] vs. 4.5 [1–11], p < 0.0001 and 15 [11–15] vs. 4 [2–14], p < 0.0001). They also made fewer errors immediately after practice (median [range], 0 [0–0] vs. 5 [3–8], p < 0.0001) and 24 h later, (0 [0–3] vs. 6.5 [3–8], p < 0.0001 and 0 [0–3] vs. 4 [2–7], p < 0.0001). ConclusionCombining deliberate practice with metrics improved acquisition of needling skills.

Gross Anatomy Review for Anesthesiology Residents on the Acute Pain Service: How Basic Science Training Could Improve Knowledge and Confidence

INTRODUCTIONThe Anesthesiology Acute Pain Service (APS) manages peri‐operative pain using ultrasound‐guided peripheral nerve blocks (PNB). PNB success is dependent on detailed anatomical knowledge, which residents may not have formally reviewed in years. GOALS. This study describes and evaluates a novel strategy for improving residency education using an instructor‐led Cadaver Review session that provides anatomical context to APS residents.METHODSThe curriculum for a monthly, small group, two‐hour Cadaver Review was developed to reintroduce the anatomy relevant to the most common PNBs on the APS. In each Review, an anatomist reviewed the origin, function, and key relationships of major peripheral nerves, while an APS attending integrated the anatomy with PNB methods and cases. Strategies were used to encourage active, hands‐on learning. An IRB‐exempt survey was distributed post‐Review to all participants (March – November 2017, N = 31). Likert responses (5 = strongly agree) were analyzed to evaluate the impact of the Review on the residents' confidence with anatomy (7 items) and perceptions (4 items). For a subgroup of residents (N = 8), change in pre‐/post‐test confidence and perception ratings were also compared using an unpaired t‐test.RESULTS94% of participants completed post‐Review surveys and 100% completed pre‐/post‐test surveys. Mean time since their last anatomy course was 6.9 years. After the Review, 89% of participants felt more confident in their knowledge of nerve origins (mean = 4.3), 86% reported greater confidence in cutaneous innervation (mean = 4.2), and 88% noted an increase in confidence with both muscle innervation (mean = 4.1) and key relationships (mean = 4.3). Participants also felt more confident identifying anatomy on illustrations (83%, mean = 4.2), cadavers (90%, mean = 4.3), and ultrasound (86%, mean = 4.2). 93% of participants found the Review accessible (mean = 4.7) and 95% would recommend it (mean = 4.5). Participants believed their reinforced knowledge would also improve future clinical (88%, mean = 4.4) and board exam (85%, mean = 4.3) performance. Residents in the preliminary pre‐test/post‐test subgroup showed significant increases (p ≤ 0.05) in their self‐reported confidence with the anatomy knowledge and identification items, suggesting that the Review had a positive impact on residents' education. Belief that the Review would improve future clinical and board exam performance also increased (meanPre = 4.1 vs meanPost = 4.9; meanPre = 4.3 vs meanPost = 4.9 respectively), although not significantly.CONCLUSIONSThe Review improved anesthesiology residents' confidence with anatomy by integrating basic science and residency training, and was highly valued. Further study is needed to discern the impact of the Review on residents' anatomical knowledge and clinical outcomes. Similar basic sciences adjuncts may also benefit residents from other specialties.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

How central is central poststroke pain? The role of afferent input in poststroke neuropathic pain: a prospective, open-label pilot study.

Central poststroke pain (CPSP) is a neuropathic pain disorder, the underlying mechanisms of which are not well understood. It has been suggested that stroke-associated loss of inhibitory neurons in the spinothalamic tract causes disinhibition of thalamic neurons, which autonomously generate ectopic nociceptive action potentials responsible for the pain experience. We hypothesized that CPSP is a result of misinterpretation of afferent sensory input by the sensitized neurons within the brain, rather than generated spontaneously by the damaged central nervous system (CNS) neurons. To test this hypothesis, we prospectively recruited 8 patients with definite CPSP affecting at least 1 extremity. In an open-label intervention, an ultrasound-guided peripheral nerve block with lidocaine was performed to block afferent sensory input from a painful extremity. Spontaneous and evoked pain, neuropathic pain descriptors, and lidocaine plasma concentrations were measured. The blockade of peripheral sensory input resulted in complete abolition of pain in 7 of the 8 subjects within 30 minutes (the primary outcome measure of the study), and >50% pain relief in the remaining participant. Median (interquartile range) spontaneous pain intensity changed from 6.5 (4.3-7.0) at baseline to 0 (0-0) after the block (P = 0.008). All mechanical/thermal hypersensitivity was abolished by the nerve block. The results suggest that it is unlikely that CPSP is autonomously generated within the CNS. Rather, this pain is dependent on afferent input from the painful region in the periphery, and may be mediated by misinterpretation of peripheral sensory input by sensitized neurons in the CNS.

The European Society of Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine Recommendations on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia.

Dosage of local anesthetics (LAs) used for regional anesthesia in children is not well determined. In order to evaluate and come to a consensus regarding some of these controversial topics, The European Society of Regional Anaesthesia and Pain Therapy (ESRA) and the American Society of Regional Anesthesia and Pain Medicine (ASRA) developed a Joint Committee Practice Advisory on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia. Representatives from both ASRA and ESRA composed the joint committee practice advisory. Evidence-based recommendations were based on a systematic search of the literature. In cases where no literature was available, expert opinion was elicited. Spinal anesthesia with bupivacaine can be performed with a dose of 1 mg/kg for newborn and/or infant and a dose of 0.5 mg/kg in older children (>1 year of age). Tetracaine 0.5% is recommended for spinal anesthesia (dose, 0.07-0.13 mL/kg). Ultrasound-guided upper-extremity peripheral nerve blocks (eg, axillary, infraclavicular, interscalene, supraclavicular) in children can be performed successfully and safely using a recommended LA dose of bupivacaine or ropivacaine of 0.5 to 1.5 mg/kg. Dexmedetomidine can be used as an adjunct to prolong the duration of peripheral nerve blocks in children. High-level evidence is not yet available to guide dosage of LA used in regional blocks in children. The ASRA/ESRA recommendations intend to provide guidance in order to reduce the large variability of LA dosage currently observed in clinical practice.

Our Ultrasound Guided Brachial Plexus Block Experiences for Upper Extremity Surgeries in Pediatric Patients

Objectives:Brachial plexus block is the most effective analgesia and anesthesia procedure for the upper extremity surgeries in pediatric patients. In recent years, ultrasound guidance for this procedure has reduced the fail and complications like pneumothorax, intravascular injection and nerve damage. However, the number of studies about brachial plexus block is not enough, particularly in pediatric patients, which remained under-researched. In our study, we aimed to discuss the efficacy and safety of the ultrasound-guided brachial plexus block in pediatric patients by retrospectively examining their data.Methods:We retrospectively reviewed the data of pediatric patients who underwent ultrasound-guided brachial block in our clinic between January 2015-January 2017. Demographic data, diagnosis, procedure and operation times, medications, motor and sensorial block times were recorded.Results:Between January 2015 and January 2017, the number of pediatric patients who underwent ultrasound-guided peripheral nerve block in our clinic was 24. In 15 of these patients, the supraclavicular block was applied in 15, and the infraclavicular block was applied in nine patients. The mean age of the patients was 9.6±3.12, with a male/female ratio 14/10. The mean duration of the procedure was 9.54±2.14 minutes in patients for the supraclavicular block and 12.9 ± 2.8 minutes for the infraclavicular block. The mean surgery time was 64±13.6 minutes. As a local anesthetic, bupivacaine was used in three patients; bupivacaine+lidocaine combination was used in 21 patients and adjuvants were added in eight patients. The block procedure was performed under general anesthesia in 12 patients and under sedation in 12 patients. The mean motor block time was 7.5±2 hours in patients who received supraclavicular block, and 7.4±1.5 hours in patients who received infraclavicular block. The mean sensorial block time was 10.5±1.7 hours in the supraclavicular block, and 10.45±1.15 hours in the infraclavicular block. The mean motor block period with added adjuvants was 7.7±0.5 hours, and the sensorial block period was 11.12±1.1 hours. No complications were seen during the procedure, intraoperative and postoperative follow-up.Conclusion:Ultrasound-guided brachial plexus block in pediatric patients is effective and safe, with longer analgesia duration and lower complication rates. Prospective studies with a larger number of patients are needed in this regard.

Ultrasound-Guided Popliteal Sciatic Nerve Block for an Ankle Laceration in a Pediatric Emergency Department

Although ultrasound-guided peripheral nerve block has recently been introduced into pediatric emergency departments, knowledge of its use is limited. We present here a case demonstrating the safety and effectiveness of ultrasound-guided popliteal sciatic nerve block for a pediatric spoke injury in a pediatric emergency department setting.

Erratum to: Ultrasound-guided interscalene brachial plexus block in achild with acute upper respiratory infection.

The brachial plexus is commonly blocked at the interscalene level for shoulder and proximal humeral surgery. There are only a few publications about the interscalene technique in pediatric patients for a peripheral nerve block. Ultrasound-guided peripheral nerve block has become increasingly more popular for pediatric patients because of high success rates and safety concerns. We used ultrasound-guided interscalene brachial plexus block in an 18-month-old child with an acute upper respiratory infection who had a supracondylar fracture of the humerus.

Possible utility of contrast-enhanced ultrasonography for detecting spread of local anesthetic in nerve block.

This study demonstrated the effects of perfluorobutane (Sonazoid®) with contrast-enhanced ultrasonography (CEUS) to identify the spread of local anesthetics in ultrasound-guided nerve block. This study consists of simulation, cadaveric, and animal studies. In a simulation study, 1% lidocaine with 10- to 1000-fold diluted Sonazoid®, a US-specific contrast agent to diagnose hepatic and breast cancers (0.5mL), was injected into a resin-based phantom to determine the optimal concentration for ultrasound-guided peripheral nerve block. The enhanced area was measured by direct observation and ultrasonography (US). In the cadaver study, ultrasound-guided sciatic nerve block was performed at the popliteal fossa in the 9 extremities, and 5mL of the optimally diluted Sonazoid® defined in the simulation study with X-ray contrast medium and blue dye was injected. Longitudinal spread of the solution was measured by CEUS, X-ray imaging and anatomical dissection. In the animal study, the optimally diluted Sonazoid® was injected around the sciatic nerve of rats (n=6), and neuronal function and toxicity were evaluated by behavioral and histological estimation. The simulation study proved that 100-fold diluted Sonazoid® was the optimal concentration. In the cadaver study, CEUS and anatomical dissection (r=0.90, P=0.0020) or radiography (r=0.84, P=0.0072) showed high agreement and correlation with the longitudinal spread. CEUS clearly showed a fine intraneuronal injection image compared to the usual B-mode imaging. The animal study suggested no adverse effects by co-administration of lidocaine and Sonazoid®. CEUS with 100-fold diluted Sonazoid® could identify the spread of local anesthetic as well as radiography and anatomical dissection, and distinguish between intra- and extraneuronal injections without neurodegeneration.

Value of probe sterile protective film when applied to ultrasound-guided peripheral nerve block

Objective To evaluate the value of probe sterile protective film when applied to ultrasound-guided peripheral nerve block. Methods Ninety American Society of Anesthesiologists physical status Ⅰ or Ⅱpatients who required ultrasound-guided lumbar plexus block, aged 18-60 yr, weighing 55-85 kg, were randomly divided into 3 groups (n=30 each): sterile protective film group (group F), traditional physical method group (group TP) and traditional chemical method group (group TC). The probe was sterilized using a sterile protective film in group F, using a sterile glove in group TP, and using 70%-80% alcohol in group TC.Microbiological detection of probe was carried out subsequently, and the relative sterility was defined as the total number of colonies was less than or equal to 5 cfu/cm2.The time spent in sterilizing probe and in performing lumbar plexus block was recorded.The sterile qualified rates of scanning surface and handle of probe were calculated.The ultrasonic image quality was assessed by using a 4-point scale, and the number of display areas was recorded by Moro method. Results Compared with group TP, the time spent in sterilizing probe and in performing lumbar plexus block was significantly prolonged, the sterile qualified rate of probe handle and ultrasonic image quality were increased, and the number of display areas was increased in group F (P<0.05). Compared with group TC, the time spent in sterilizing probe was significantly shortened, and the sterile qualified rates of scanning surface and handle were increased in group F (P<0.05 or 0.01). Conclusion The probe sterile protective film exerts simple operation, strict sterile effect and little influence on ultrasonic image, the efficacy is superior to that of traditional methods, and it is more suitable for probe sterilization when applied to ultrasound-guided peripheral nerve block. Key words: Ultrasonography; Nerve block; Sterilization

Ultrasound-guided Supraclavicular Nerve Block In-plane Technique: Comparison of Conventional vs Skin Wheal Standoff Technique

Introduction: The foremost advantage of ultrasound-guided peripheral nerve blocks is visualization of anatomical structures of interest and then depositing the local anesthetic for block. Supraclavicular block is the very commonly used block for upper limb surgeries. Aim: The aim of our study is that for greater efficacy and safety of our blocks, we should use a technique in which we are not only visualizing the anatomical structures, but also the complete needle path and ultimately the deposition of local anesthetic in the vicinity of nerves and having a safe distance from adjacent structures like vessels and pleura. Materials and methods: A total of 60 patients were accepted for study and divided into two groups of 30 each randomly. In group I, ultrasound-guided supraclavicular nerve block was given with skin wheal oblique standoff technique and in group II, the usual technique. Both the groups were compared in terms of better needle visualization, number of attempts, and success of block. Results: In group I, we were able to visualize the complete path of needle in 70% of cases in first attempt as compared with group II in 40% of cases. In group I, 70% of blocks were placed in the first attempt as compared with 33% in group II. The p-value was <0.005 and difference was statistically significant. Similarly, operator fatigue, time for block placement, and corner pocket visualization were better in group I. Conclusion: We have an opinion and recommendation from this study that by simple modification of the usual technique of giving supraclavicular block, i.e., raising a skin wheel, we can achieve greater success with our procedure.

Ultrasound-guided percutaneous cryoneurolysis providing postoperative analgesia lasting many weeks following a single administration: a replacement for continuous peripheral nerve blocks?: a case report.

Cryoneurolysis entails using low temperatures to reversibly ablate nerves, with a subsequent analgesia duration measured in weeks or months. Previously, clinical applications for acute pain were limited because treatment originally required exposing the target nerve surgically. However, three developments have now made it possible to provide prolonged postoperative analgesia by cryoneurolysis: 1) new portable, hand-held cryoneurolysis devices, 2) ultrasound machine proliferation, and, 3) anesthesiologists trained in ultrasound-guided peripheral nerve block administration. This report is the first to describe the use of a single preoperative administration of ultrasound-guided percutaneous cryoneurolysis to provide multiple weeks of analgesia following shoulder rotator cuff repair and total knee arthroplasty. Considering the significant benefits of cryoanalgesia relative to continuous peripheral nerve blocks (e.g., lack of catheter/pump care, extremely long duration), this analgesic modality may be a practical alternative for the treatment of prolonged post-surgical pain in a select group of surgical patients.

Analgestic Benefits of Ultrasound-Guided Thoraco-Abdominal Wall Peripheral Nerve Blocks

Analgestic Benefits of Ultrasound-Guided Thoraco-Abdominal Wall Peripheral Nerve Blocks

Analgesic Benefits of Ultrasound-Guided Thoraco-Abdominal Wall Peripheral Nerve Blocks

Background and Objectives:Peripheral nerve blocks have been associated with decreased opiate consumption along with decreased associated side effects, improved pain scores, improved patient satisfaction scores, and decreased hospital length of stay. The aim of this review is to describe the use of ultrasound-guided thoraco-abdominal wall peripheral nerve blocks for perioperative analgesia.Content:This review article discusses the indications, anatomy, techniques, risks, and available clinical evidence of ultrasound-guided transversus abdominis plane (TAP), paravertebral, PECS, rectus sheath, and ilioinguinal/ iliohypogastric truncal blocks to update practitioners on the utility of these interventions in perioperative pain management.Conclusion:The increased use of ultrasound guidance in the performance of regional anesthesia has increased the tools available to physicians to provide analgesia in patients with thoraco-abdominal pain after surgery and trauma.

Abstract PR501

Background & Objectives: Ultrasound-guided (USG) peripheral nerve block allows for visual verification of the relationship between sciatic nerve and local anesthetic (LA). Nerve stimulation guidance may help to prevent intraneural injection of LA. This clinical investigation aimed to estimate the minimum effective anesthetic volume (MEAV) of ropivacaine 0.5% required to block the sciatic nerve at subgluteal injection under guidance of ultrasound with nerve stimulation in 90% patients. Materials & Methods: Patients with an American Society of Anesthesiologists physical status I-II who were scheduled for arthroscopic meniscus or cruciate ligaments repair of knee were eligible for study inclusion. All patients underwent blockade of both the lumbar plexus as well as the sciatic nerve using ultrasound and nerve stimulation to identify nerve location. Sixteen ml 0.5% ropivacaine was administered to the first patient for sciatic block. Dosing of subsequent patients was determined using Dixon and Massey up-and-down sequential method. After administration of the anesthetic, sensory and motor function of the tibial and common peroneal nerve were assessed by a blinded observer. After undergoing the surgical procedure, patients were followed in the hospital for 48 hours. Clinical follow up was continued for one month. Effective volume of ropivacaine 0.5% for sciatic nerve block was calculated using the probit analysis with Dixon’s up-and-down method. Results: Twenty-six patients between the ages of 18 and 48 years old were treated as part of the study. Fifteen patients (58%) had successful sciatic nerve block and 11 had failed block of sciatic nerve. The EV90 of ropivicaine (0.5%) was 13.0 ml (95% CI 12.6–15.0). For all patients VAS at rest was no higher than 2 and VAS at movement was no higher than 4 within the first 48 hours after surgery. At the time of the 1-month follow-up, no neurologic complications were noted. Conclusion: When the sciatic nerve is carefully targeted using both ultrasound and nerve stimulation, successful blockade of the nerve during surgery and appropriate postoperative analgesia is achieved in 90% of patients at a dose of 13.0 mL.

Holistic ultrasound in trauma: An update

Holistic ultrasound is a total body examination using an ultrasound device aiming to achieve immediate patient care and decision making. In the setting of trauma, it is one of the most fundamental components of care of the injured patients. Ground-breaking imaging software allows physicians to examine various organs thoroughly, recognize imaging signs early, and potentially foresee the onset or the possible outcome of certain types of injuries. Holistic ultrasound can be performed on a routine basis at the bedside of the patients, at admission and during the perioperative period. Trauma care physicians should be aware of the diagnostic and guidance benefits of ultrasound and should receive appropriate training for the optimal management of their patients.In this paper, the findings of holistic ultrasound in trauma patients are presented, with emphasis on the lungs, heart, cerebral circulation, abdomen, and airway. Additionally, the benefits of ultrasound imaging in interventional anaesthesia techniques such as ultrasound-guided peripheral nerve blocks and central vein catheterization are described.

Application of ultrasound-guided peripheral nerve block technique in standardized training for resident doctors

Mastering peripheral nerve block technique is a basic requirement for residents standardization training. Ultrasound-guided nerve block has broken through the limitation of traditional blind operation, promoted the quality and safety of anesthesia, and improved the quality of the peripheral nerve block teaching. However, the safety of ultrasound-guided nerve block technique must be based on the speci-fication training. In the teaching experience, we have used theoretical study, simulation training and clinical practice to explore a new method for upgrading the quality of resident doctor training. Key words: Ultrasound; Peripheral nerve block; Resident standardization training

Emergency Transfemoral Amputation in a Severely Sick and Hemodynamically Unstable Patient through Eco-Guided Peripheral Nerve Block: Case Report

Critically ill and/or anticoagulated patients remain a great challenge for anesthesiologists regarding the anesthetic procedure. Its perioperative management should focus on organ preservation and avoid further damage. In this context, ultrasound-guided regional blocks are essential tools, as they avoid neuraxial invasion and deterioration in borderline hemodynamics, conferred by spinal anesthesia and general anesthesia, respectively. In this report, we present a case of a patient with septic shock, anticoagulated, and in need of an emergency surgical approach in the right lower limb in which ultrasound-guided peripheral nerve block was essential for a favorable outcome for the patient. Case Report: Patient in septic shock in need of amputation of the right lower limb at the level of the thigh, with unstable hemodynamics and severe respiratory conditions, undergoing ultrasound-guided peripheral nerve block, of the right femoral, sciatic and lateral cutaneous nerves of the thigh, as a single anesthetic technique. Conclusion: Regional anesthesia of the peripheral nerve guided by ultrasound as a unique anesthetic technique, performed by experienced professionals or under supervision, is effective and safe for lower limb surgical procedures. We suggest this approach, especially in hemodynamically borderline patients or seriously ill with or without anticoagulation.