Background and Aims Patients with 3rd degree AV block undergoing surgery are more likely to develop severe bradycardia and hemodynamic instability increasing the risk of perioperative complications. Regional anesthesia is preferable for these patients as it is accompanied with minimal effects on the cardiovascular system. We present a case report of a patient with complete heart block undergoing urgent lower limb surgery under peripheral nerve block.

Methods A 43 years old man was admitted for Achilles tendon rupture repair. His history revealed nothing but a congenital known 3rd degree heart block. The patient was asymptomatic even during exercise, presenting an average heart rate of 40bpm. After a thorough perioperative evaluation we decided to proceed with surgery, using intraoperatively isoprenaline if needed and having in position a temporary cardiac pacer in a case of hemodynamic instability. The surgery was conducted after a sciatic nerve block was performed, under ultrasound and nerve stimulation guidance, in parallel. A mixture of 1% lidocaine and 0.5% ropivacaine was used, and the patient was placed in the prone position.

Results Intraoperatively the patient remained hemodynamically stable, with a nonfluctuating heart rate of 40 bpm. The surgery was completed uneventfully, with no complaints of pain or discomfort. No cardiac complications were reported in the postoperative period.

Conclusions Peripheral nerve blocks remain a safe and useful anesthetic option for high-cardiac-risk patients. They provide minimal hemodynamic changes, excellent analgesic effects and fewer perioperative cardiopulmonary complications.