{
  "abstract": "Background and Aims We present the case of an 80-year-old gentleman who underwent successful angioplasty and stenting of the left popliteal artery under regional anaesthesia. This followed a failed attempt under local anaesthesic due to patient factors, namely agitation and difficulty in positioning. The patient’s medical history included peripheral vascular disease with left second toe critical limb ischaemia, cirrhosis secondary to alcoholic liver disease with portal hypertension, coagulopathy, oesophageal varices and new ascites, severe aortic stenosis (peak velocity 4.55 m/s, mean gradient 48 mmHg, valve area 0.9 cm2), pulmonary hypertension and Barrett’s oesophagus. Our aim was to safely facilitate surgery through regional techniques, as general anaesthesia was deemed unsafe. Anaesthetic concerns included severe valvular heart disease, decompensated liver disease, current bilateral bronchopneumonia and a left quadriceps contracture making positioning challenging.Methods A popliteal sciatic block, femoral nerve block, and ilioinguinal and iliohypogastric block were performed. 10 ml of 0.25% l-bupivacaine and 5 ml of 1% lidocaine were used for each block, giving a total of 30 ml 0.25% l-bupivacaine and 15 ml 1% lidocaine. Remifentanil was infused intra-operatively at rates of 1–1.7 ng/ml and 1 mg of midazolam and 20 mg of ketamine were administered to facilitate block administration.Results The patient remained stable and comfortable throughout the procedure, requiring no haemodynamic support. Supplemental oxygen was administered via a Hudson face mask.Conclusions This case highlights the effective use of regional anaesthesia in a patient requiring emergent surgery who was unsuitable for general anaesthesia, emphasising the role this anaesthetic technique can have in facilitating such cases. Regional anaesthesia has increased in popularity in recent decades with the introduction of ultrasound and the development of safer local anaesthetic agents. Multiple studies support the use of regional anaesthesia in endovascular surgery, showing reduced morbidity, a shorter inpatient stay and a possible reduction in mortality. As such, it should be strongly considered, where appropriate, in this often-comorbid patient group.",
  "authors": [
    {
      "affiliations": [
        "Department of Anaesthesiology, St James Hospital, Dublin, Ireland"
      ],
      "name": "Oisin Friel"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, St James Hospital, Dublin, Ireland"
      ],
      "name": "David Lorigan"
    }
  ],
  "title": "P143 Regional anaesthesia for lower limb endovascular surgery – a case report",
  "uid": "d349b62c-9766-53d4-81e8-485c171c67ee"
}