Article Text

Download PDFPDF

#35531 Weathering the storm: amputation in a patient with sepsis induced multiorgan dysfunction under nerve blocks – a case report
  1. David Silva Meireles,
  2. Alexandrina Jardim Silva,
  3. Filipe Pissarra and
  4. Susana Cadilha
  1. Anasthesiology, Centro Hospitalar Lisboa Central, Lisboa, Portugal


Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)

Background and Aims Lower limb amputation is a procedure usually performed under general or neuroaxial anaesthesia. However, in certain cases as patients in multiorgan failure, peripheral nerve blocks are the only viable alternative for anaesthesia.

Methods A 68-year-old male presented with an acute limb ischemia complicated by an infected ulcer leading to sepsis and multiorgan failure. The patient had a history of diabetes, myocardial infarction and triple vessel disease waiting for CABG. Considering the patient‘s cardiac condition, septic status, acute kidney injury, acute liver failure, general and spinal anaesthesia was deemed high risk. Therefore, a combination of iliac fascia, subgluteal sciatic and obturator blocks was proposed for anaesthesia to a life-saving transfemoral amputation. The procedure was carried out under sedation with dexmedetomidine and ketamine.

Results The patient had adequate anaesthesia and remained hemodynamically stable throughout the surgery and the postoperative period. Sedation in this procedure was required for the comfort of the patient and analgesia adjuvant.

Conclusions Sepsis induced multiorgan dysfunction is a challenge for the anaesthesiologist due to general and spinal anaesthesia side effects. Nerve blocks with sedation could be a safe alternative for anaesthesia in septic patients proposed for limb amputation.

  • sepsis
  • amputation
  • regional anaesthesia
  • peripheral nerve blocks

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.