Background: We report on a case of combined sciatic nerve block and 3-in-1 block for amputation of lower limb in an ASA IV-V patient 6 days after intraoperative cardiopulmonary resuscitation following induction of general anaesthesia.
Case report: A 54-year old male patient was admitted for necrosectomy of a crural ulcer due to end-stage peripheral vascular disease and non-insulin dependent diabetes mellitus. The patient also suffered from toxic cardiomyopathy. After induction for general anaesthesia the haemodynamic situation deteriorated progressively and ended up in cardiac arrest with consequent successful cardiopulmonary resuscitation. The operation was cancelled and the patient was admitted to the intensive-care unit, where he was extubated after 2 days of further haemodynamic stabilisation. Following development of a septic situation of the lower limb the patient was again admitted for amputation six days after the cardiopulmonary resuscitation. Regional anaesthesia was conducted with a combination of a sciatic nerve block via the posterior approach and a 3-in-1 block facilitated by ultrasonographic guidance. For each of the blocks we used 20 mL mepivacaine 1%. Sensory blockade was sufficient and the patient remained haemodynamic and respiratorily stable.
Discussion and conclusions: The combined sciatic and 3-in-1 block is a rarely used technique, but for haemodynamically unstable patients it is a safe method for surgery of the lower limb.