Background and Aims Patients with Eisenmenger syndrome undergoing non-cardiac surgery consist a great challenge regarding anesthesia management. Both general and neuraxial anesthesia can cause acute shifts in the arterial pressure and excessive hemodynamic changes, leading to potential hazardous results. We present a patient with Eisenmenger syndrome undergoing urgent lower limb surgery under peripheral nerve blockade.

Methods A 62 years old female was admitted for surgical repair of a trimalleoar fracture. Her medical history revealed Eisenmenger syndrome due to congenital Ventricular Septal Defect (VSD), with severe pulmonary hypertension (70–75mmHg). In room air conditions she maintained SpO2 and pO2 values of 83% and 56mmHg, respectively. Sciatic and femoral nerve blocks were performed under ultrasound guidance and concurrent use of nerve stimulator, administering 15 ml of ropivacaine 0.5% at each block site. The patient was then placed in prone position for 2 hours until the end of the surgery. Invasive arterial blood pressure monitoring was used while 2mg of midazolam were used as an anxiolytic agent.

Results Intraoperatively the patient remained hemodynamically stable, and the surgery was completed uneventfully. The patient experienced no pain, reporting minor discomfort due to the prolonged prone position. Postoperatively no supplemental analgesia was required while no complications were reported.

Conclusions Peripheral nerve blocks in high-risk cardiac patients constitute a safe and efficacious alternative technique for anesthesia management. They offer hemodynamic stability, along with satisfactory postoperative pain scores and less perioperative complication rates.