Peripheral nerve blocks for above knee amputation in high-risk patients

Area of Science:

• Anesthesiology
• Surgical Innovation
• Patient Outcomes

Background:

• Above-knee amputation (AKA) carries significant risks.
• Limited data exists on using peripheral nerve blocks (PNB) as the sole anesthetic for high-risk AKA patients.

Purpose of the Study:

• To evaluate the efficacy and outcomes of PNB as the sole anesthetic technique for high-risk patients undergoing AKA.
• To assess the clinical outcomes associated with this anesthetic approach.

Main Methods:

• Retrospective descriptive study of 57 patients with ASA IV status undergoing AKA with PNB (January 2010 - December 2016).
• Primary outcome: surgical success. Secondary outcomes: block details, hemodynamics, sedation/analgesia use, comorbidities, and mortality (30-day and 1-year).

Main Results:

• 91% of patients successfully underwent AKA using PNB.
• Most patients (95%) required intraoperative sedation and analgesia.
• Combined femoral, obturator, and sciatic (FOS) nerve blocks were used in 67%, with 33% using femoral and sciatic blocks only, showing higher sedation needs (p=0.013).
• 30-day and 1-year mortality rates were 12.3% and 47.4%, respectively.
• Hemodynamics remained largely stable during surgery.

Conclusions:

• Peripheral nerve blocks (PNB) are a viable and reliable anesthetic choice for high-risk patients undergoing above-knee amputation (AKA).
• Utilizing combined femoral, obturator, and sciatic (FOS) nerve blocks may reduce the requirement for intraoperative sedation and analgesia.