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Lower extremity bypass with tumescent local anesthesia.

Daniel I Fremed¹, Jennifer C Grom², Peter L Faries¹

¹Division of Vascular Surgery, The Mount Sinai Medical Center, New York, NY.

Journal of Vascular Surgery Cases and Innovative Techniques

|June 14, 2019

Summary

Tumescent anesthesia offers a safe alternative for high-risk patients undergoing lower extremity bypass surgery for critical limb ischemia when general anesthesia is not an option. This technique provided effective pain management, allowing successful surgical intervention and patient discharge.

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Area of Science:

Vascular Surgery
Anesthesiology
Pain Management

Background:

Critical limb ischemia necessitates lower extremity bypass surgery, often in patients with high surgical risk due to comorbidities.
General anesthesia or neuraxial blockade may be contraindicated in these high-risk individuals.

Observation:

A case study involving a patient with critical limb ischemia and high anesthesia risk was presented.
The patient could not undergo general anesthesia or neuraxial blockade.

Findings:

An infrainguinal bypass was successfully performed using tumescent anesthesia with minimal intravenous sedation.
The patient was discharged 6 days post-surgery, with a postoperative groin lymphocele as the main complication.

Implications:

Tumescent local anesthesia presents a viable alternative pain management strategy for select patients undergoing lower extremity bypass.
This approach may expand surgical options for high-risk patients with critical limb ischemia.