Peripheral Nerve Blocks as a Primary Anesthetic for Above-the-Knee Amputations: A Prospective Feasibility Study

Area of Science:

• Anesthesiology
• Surgical Procedures

Background:

• Above-the-knee amputation is a high-risk procedure with significant morbidity and mortality.
• The safety and efficacy of peripheral nerve blocks with deep sedation for this surgery remain unclear.
• The influence of anesthetic type on perioperative mortality is not well-established.

Purpose of the Study:

• To evaluate the feasibility and safety of using peripheral nerve blocks and deep sedation for above-the-knee amputations.
• To assess patient outcomes, including pain, satisfaction, and mortality, in this anesthetic approach.

Main Methods:

• A prospective, proof-of-concept study involving 29 patients undergoing above-the-knee amputation.
• Preoperative placement of femoral and sciatic nerve catheters, with obturator and lateral femoral cutaneous nerve blocks.
• Administration of deep sedation during the surgical procedure.

Main Results:

• 90% of patients reported zero pain in the post-anesthesia care unit.
• 96.7% of patients were satisfied or extremely satisfied with their anesthetic care.
• One patient required conversion to general anesthesia; one patient died within 30 days postoperatively.

Conclusions:

• Peripheral nerve blocks with deep sedation appear to be a reliable and feasible anesthetic option for above-the-knee amputations.
• This approach may be particularly beneficial for high-risk surgical patients.
• Further research is necessary to confirm the impact of anesthetic type on patient outcomes.