Continuous Spinal Anaesthesia for Below Knee Amputation in High Risk Case: A Case Report

Introduction: Lower limb ischemia, peripheral arterial disease, and diabetes mellitus are considered the major cause for limb amputations in more than 50% of cases. These patients have increased risk of perioperative mortality and morbidity due to additional comorbidities, such as cardiac diseases. Continuous spinal anaesthesia (CSA) provides better cardiovascular stability, less local anaesthetic requirement, better control of anaesthesia level and lower risk of local anaesthetic toxicity were reported in the CSA technique compared with a single-dose spinal anaesthesia technique. We reported a high-risk patient who underwent below knee amputation surgery under CSA. Case Report: This is a 50-year-old male, American Society of Anaesthesiologists (ASA) III, dilated cardiomyopathy admitted for below knee amputation surgery. Preop vitals are stable. Blood investigations are normal. Chest radiography showed cardiomegaly, and echocardiography revealed sinus tachycardia with poor R wave progression and low ejection fraction (EF) of 20%. Continuous spinal anaesthesia was planned for the procedure, during the surgery total amount of fluid given was 40 mL of crystalloids at the rate of 20ml/hr. Intraop vitals stable. The patient was transferred to post op ward following the removal of spinal catheter. No anaesthetic complications noted. Conclusion: We reported the successful anaesthetic management of a patient with coronary artery disease and low ejection fraction undergoing below knee amputation surgery. CSA technique with low dose hyperbaric bupivacaine provided safe and effective ananaesthesia with minimal haemodynamic changes for this case.