{
  "abstract": "Background and Aims Lower limb amputations in patients with peripheral arterial disease present significant anesthetic challenges due to advanced age and multiple comorbidities. When general and neuraxial anesthesia are contraindicated, carry high risk, or are technically unsuccessful, peripheral nerve blocks may offer a safe and effective alternative.Methods An 89-year-old male (ASA III) was admitted with right hallux ischemia and necrosis, signs of local infection, and concurrent pneumonia. His medical history included atrial fibrillation on anticoagulation, hypertension, and hypertensive cardiomyopathy. He was started on piperacillin-tazobactam and scheduled for an above-knee amputation. Given the pulmonary infection, general anesthesia was deemed high risk. Spinal anesthesia was attempted using 8 mg levobupivacaine and 2.5 mcg sufentanil. Due to challenging anatomy and technical difficulty, three experienced anesthesiologists performed multiple punctures. Although cerebrospinal fluid was obtained, no sensory block developed, and the surgery was postponed. Four days later, considering the procedure’s semi-urgent nature and persistent pneumonia, surgery proceeded under regional anesthesia. Ultrasound-guided peripheral nerve blocks were performed with 0.5% ropivacaine, targeting the femoral, sciatic, obturator, and lateral femoral cutaneous nerves. Supplemental moderate sedation was also used.Results The nerve blocks provided adequate anesthesia for the procedure, which was completed without complications. The patient had an uneventful postoperative recovery and was discharged on postoperative day four. This approach has been shown to provide effective anesthesia with minimal hemodynamic instability in high-risk patients.Conclusions This case illustrates the utility of ultrasound-guided peripheral nerve blocks as a safe and effective anesthetic strategy in high-risk elderly patients, especially when both general and neuraxial anesthesia are contraindicated, carry high risk, or fail.",
  "authors": [
    {
      "affiliations": [
        "Anaesthesiology, Unidade Local de Saúde da Região de Leiria, Leiria, Portugal"
      ],
      "name": "Ricardo Madeira"
    },
    {
      "affiliations": [
        "Anaesthesiology, Unidade Local de Saúde da Região de Leiria, Leiria, Portugal"
      ],
      "name": "Luísa Carvalho"
    },
    {
      "affiliations": [
        "Anaesthesiology, Unidade Local de Saúde da Região de Leiria, Leiria, Portugal"
      ],
      "name": "Luís Gonçalves"
    },
    {
      "affiliations": [
        "Anaesthesiology, Unidade Local de Saúde da Região de Leiria, Leiria, Portugal"
      ],
      "name": "Tânia Barros"
    },
    {
      "affiliations": [
        "Anaesthesiology, Unidade Local de Saúde da Região de Leiria, Leiria, Portugal"
      ],
      "name": "Francisca Santos"
    },
    {
      "affiliations": [
        "Anaesthesiology, Unidade Local de Saúde da Região de Leiria, Leiria, Portugal"
      ],
      "name": "Décia Gonçalves"
    }
  ],
  "title": "P184 When everything fails but the nerves: peripheral blocks in high-risk limb amputation",
  "uid": "ab6239e9-f9f6-5178-8a5b-0f2b87192871"
}