Background and Aims Above knee amputation (AKA) is associated with considerable mortality and morbidity. There is paucity of data describing the use of peripheral nerve blocks (PNB) as the sole anaesthetic technique in patients undergoing AKA.

Methods A 65 years old man (weight 60kg) diagnosed with diabetic ketoacidosis was found in cardiac arrest short after admission. Advanced life support was successfully performed. His medical history was significant for ischemic heart disease, heart failure, peripheral artery disease, chronic kidney disease and had an implantable defibrillator. A two-dimensional echocardiogram showed a 10% left ventricular ejection fraction. He was then transferred to the Intensive Care Unit. During his stay an acute limb ischemia was diagnosed. Unfractionated heparin was started, and he was proposed for a life-saving AKA. He presented to the operating room with non-invasive ventilation and vasopressor support. We performed echo-guided subgluteal sciatic, obturator and femoral nerve blocks with 0.5% ropivacaine. Supplemental sedation with dexmedetomidine was used. The surgical procedure was uneventful and the patient remained hemodynamically stable.

Results We were left with few anaesthetic options. General anaesthesia was too risky in such an unstable patient. Subarachnoid block was contraindicated. We ended up performing regional blocks as the sole anaesthetic technique.

Conclusions Although challenging and sometimes requiring supplemental sedation PNB can be a viable option for AKA in high-risk patients.