Ultrasound-guided femoral and sciatic nerve blocks in an anticoagulated patient. Case reports

The use of the ultrasound to guide the puncture in peripheral nerve blocks has become increasingly more frequent. With the lower probability of promoting vascular damage the ultrasound has become an interesting tool in peripheral nerve blocks especially in patients in use of anticoagulants or with coagulopathies. The objective of this article was to report two cases in which ultrasound-guided sciatic and femoral nerve blocks were performed in anticoagulated patients.

In the first case, the patient underwent amputation of the left forefoot due to necrosis and signs of infection, and in the second case, surgical cleaning of the left knee. Patients had changes in coagulation with levels of activity of prothrombin and activated partial thromboplastin time above normal limits. Both patients underwent ultrasound-guided femoral and sciatic nerve blocks, evolving without motor or sensorial changes in the territories of those nerves and without hematoma at the site of puncture.

Anticoagulation imposes some restrictions to classical regional anesthetic techniques. With the development of ultrasound equipment and methods, it is now possible to accurately identify vascular and neural structures. This allows ultrasound-guided puncture to be more precise, both to achieve the area of interest and to minimize the risks of accidental vascular damage. Until now, peripheral block was not recommended in anticoagulated patients or in those with coagulopathies. However, considering that few reports on ultrasound-guided regional blocks in coagulopathies can be found in the literature, the safety of this technique in this condition has yet to be established.