Ultrasound-Guided Sciatic and Femoral Block in Patient with Recent Embolism Stroke Undergo Amputation Above the Knee

Propan Hanggada Satyamakti Mubarak


Background: Patients undergoing amputation of the lower extremities usually have poor circulation and other comorbidities and, therefore, present a challenge to the anesthesiologist. The combination of sciatic and femoral nerve block is reported to be an effective anesthetic technique for patients undergoing knee surgery, and it is known to be an effective method of postoperative analgesia in patients undergoing major surgery on the subject's lower extremities.

Case: A 70-year-old man with a recent embolism stroke, death of his limb on the right cruris region, and underwent an amputation above the knee. Preoperative physical examination showed GCS E4 V, motor aphasia M6, blood pressure 131/82 mmHg, pulse 114 bpm, RR 20 times/minute with bodyweight 70 kg, height 160 cm, SpO2 97%. There was cyanosis in the right cruric region with motor power of 1/5 1/5. The value of leukocytes 18,600/ul, platelets 309,000/ul, Prothrombin Time (PT) 15.8 seconds, Activated partial thromboplastin time (APTT) 25.9 seconds,  International normalized ratio (INR) 1,330, neutrophils 81.7%, lymphocytes 12.6%, creatinine 1.8 mg/dl, urea 137 mg /dl, blood sugar at the time 258 mg/dl, Cl 95 mmol/l.  This case report suggests that ultrasound-guided peripheral nerve blocks may be useful for major lower extremity surgery in patients with severe hemodynamic impairment.

Conclusion: Perioperative management of embolism stroke patients undergoing above-knee amputation requires special attention in selecting anesthetics. Ultrasound-guided peripheral nerve blocks minimize patient hemodynamic changes and provide better postoperative pain control.


ultrasound guided; sciatic nerve block; femoral nerve block; embolism stroke; amputation above knee

Full Text:



Bech B, Melchiors J, Børglum J, Jensen K. The successful use of peripheral nerve blocks for femoral amputation. Acta Anaesthesiol Scand. 2009;53(2):257-260. doi:10.1111/j.1399-6576.2008.01859.x

Karm MH, Lee S, Yoon SH, Lee S, Koh W. A case report: The use of ultrasound guided peripheral nerve block during above knee amputation in a severely cardiovascular compromised patient who required continuous anticoagulation. Med (United States). 2018;97(9):1-4. doi:10.1097/MD.0000000000009374

Hussien R, Ibrahim D, Abdelnaby I. Ultrasound-Guided Sciatic Nerve Block in Below Knee Amputation Surgery: Sub Gluteal Versus Popliteal Approach. . 2018:6;12(1). Open Anesth J. 2018;6(12):12-25.

Hadzic A. Hadzic’s Textbook of Regional Anesthesia and Acute Pain Management. 2nd ed. New York: Mcgraw-Hill Education; 2017.

Martin F, Martinez V, Mazoit J, Al. E. Antiinflammatory effect of peripheral nerve blocks after knee surgery: clinical and biologic evaluation. Anesthesiology. 109(3.):484-490. doi:10.1097/ALN.0b013e318182c2a1

Beilin B, Bessler H, Mayburd E, et al. Effects of preemptive analgesia on pain and cytokine production in the postoperative period. Anesthesiology. 2003;98(1):151-155. doi:10.1097/00000542-200301000-00024

Parker M, Handoll H, Griffiths R. Anaesthesia for hip fracture surgery in adults (Review). Cochrane Libr. 2004;(4):1-77. doi:10.1097/NOR.0000000000000467

Raggi R, Dardik H, Mauro AL. Continuous epidural anesthesia and postoperative epidural narcotics in vascular surgery. Am J Surg. 1987;154(2):192-197. doi:10.1016/0002-9610(87)90177-2

Khan SA, Qianyi RL, Liu C, Ng EL, Fook-Chong S, Tan MGE. Effect of anaesthetic technique on mortality following major lower extremity amputation: A propensity score-matched observational study. Anaesthesia. 2013;68(6):612-620. doi:10.1111/anae.12182

Karnik HS, Jain RA. Anesthesia for Patients with Prior Stroke. J Neuroanaesth Crit Care. 2018;05(03):150-157. doi:10.1055/s-0038-1673549

Parida S, Thangaswamy C. Cardiac tachyarrhythmias and anaesthesia: General principles and focus on atrial fibrillation. Indian J Anaesth. 2017;61:712-720. doi:10.4103/ija.IJA

Duma A, Pal S, Helsten D, Stein PK, Miller JP, Nagele P. High-fidelity analysis of perioperative QTc prolongation. Anesth Analg. 2016;122(2):439-448. doi:10.1213/ANE.0000000000001023

Anastasian ZH. Anaesthetic management of the patient with acute ischaemic stroke. Br J Anaesth. 2014;113:ii9-ii16. doi:10.1093/bja/aeu372

Martins LES, Ferraro LHC, Takeda A, Munechika M, Tardelli MA. Ultrasound-guided peripheral nerve blocks in anticoagulated patients – case series. Brazilian J Anesthesiol (English Ed. 2017;67(1):100-106. doi:10.1016/j.bjane.2015.06.005

Maulaz AB, Bezerra DC, Michel P, Bogousslavsky J. Effect of discontinuing aspirin therapy on the risk of brain ischemic stroke. Arch Neurol. 2005;62(8):1217-1220. doi:10.1001/archneur.62.8.1217

DOI: http://dx.doi.org/10.21776/ub.jap.2021.002.03.06


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.