Background and Aims Peripheral nerve blocks can be the cornerstone of perioperative anesthesia management of patients with lower limb ischemia, who often present with multiple comorbidities. The aim of this case report is to present the perioperative anesthesia management of a patient with perioperative myocardial infarction, who underwent emergent fasciotomy, after embolectomy for the treatment of ischemia of the lower limb.

Methods An 89-year-old man presented to the emergency department with ischemia of the right lower limb, due to occlusion of right external iliac artery, common, superficial and deep femoral artery. His medical history included arterial hypertension. His preoperative electrocardiogram presented signs of ischemia, while the preoperative laboratory tests included increased troponin and creatine kinase levels and signs of acute kidney injury.

Results The patient was immediately transferred to surgery for embolectomy under monitored anesthesia care. After surgery, the patient was transferred to the surgical ward, where triple antithrombotic therapy was initiated (LMWH, clopidogrel, acetylsalicylic acid), after cardiologic assessment.

The following day, the patient was transferred emergently back to surgery for fasciotomy, due to compartment syndrome. Surgery was performed under combined femoral and distal sciatic nerve block with ropivacaine 0.5% (50mg+50mg), under ultrasound guidance. No complications were reported intraoperatively and the patient was transferred to the Intensive Cardiology Unit. He was transferred back to the surgical ward the following day.

Conclusions Peripheral nerve blocks under ultrasound guidance can be a “game-changer” for the perioperative anesthetic management of patients with multiple comorbidities who must undergo an emergent surgery under antithrombotic therapy.