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Abstract
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Background and Aims Peripheral nerve blocks are widely used for surgical anesthesia as well as for acute or chronic pain management.
Methods The PNBs offer significant benefits over neuraxial or general anesthesia, as the latter may lead to respiratory and cardiovascular complications.
Results A 73-year-old male patient (ASA IV), presents with gangrene of his left arm and left arm amputation below the elbow is decided. From his medical history he suffered from lung cancer, had a cardiac pacemaker, single kidney, received medical treatment for arterial hypertension, dyslipidemia, hyperuricemia and atrial fibrillation. From his surgical history, he had undergone three surgical procedures on the afflicted arm with post - surgical admission to the ICU. His echocardiogram showed an Ejection Fraction of the left ventricle of 53% and a mitral valve stenosis. To ensure that the arm amputation could be performed without causing additional systemic harm and to avoid the need for post - surgical ICU admission, an axillary brachial plexus block was administered using 15 ml of 0.5% Ropivacaine. The patient remained hemodynamically stable throughout the perioperative period. After surgery, the patient stayed in the Post Anesthesia Care Unit for 30 minutes before being transferred to the Vascular Surgery Department, with no complications reported.
Conclusions The PNBs are a valuable alternative as a method of surgical anesthesia as well as a method of perioperative analgesia in a multimodal analgesic plan, for high risk patients, in order to reduce perioperative mortality and morbidity.
Upper arm with gangrene