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Background and Aims Total knee arthroplasty (TKA) is one of the most common orthopedic procedures and is associated with significant postoperative pain. We present a case report of a TKA performed exclusively on peripheral nerve block (PNB) anesthesia.

Methods A 61 year old female, ASA IV, presented for revision of a TKA due to primary arthroplasty infection. She had a history of hypertension, morbid obesity, mitral and aortic valvuloplasty. Most recent echocardiogram showed aortic valve with severe obstruction and indication for future repair. She was hypocoagulated with warfarin (INR preoperative 1.5). The following PNB were performed under ultrasound-guidance to obtain surgical anesthesia: femoral nerve, lateral cutaneous femoral nerve, obturator nerve, sciatic nerve (popliteal), with a total of 300 mg of ropivacaine (60 mL of 0.5% ropivacaine). Before incision a perfusion of propofol for light sedation was started and tourniquet inflated. Surgery proceeded during 2,5 hours uneventful. Patient reported a high level of satisfaction in the postoperative ward. In the following days the patient remained with a good analgesic control.

Results The standard anesthetic technique for TKA is neuroaxial anesthesia or general anesthesia. However, there are situations where those two techniques can impose increased risks and become an anesthetic challenge. As we had an urgent surgery and patient had a high INR level neuroaxial anesthesia increased risk for complications. Additionally, her valvular disease imposed an increased risk or hemodynamic stability that could be affected by general anesthetics.

Conclusions We performed an exclusive PNB anesthetic technique that was tailor-made for this patient, surgery and pain control.