A BSTRACT We present a case series of six high-risk patients with lower limb ischemia and sepsis presenting with one or more of the following clinico-pathological conditions: severe anemia, altered coagulation, ischemic dilated cardiomyopathy with severe LV dysfunction, and multiorgan failure requiring emergent or urgent lower limb surgical intervention. Ultrasound-guided peripheral nerve block is a safer alternative to neuraxial blockade in patients with coagulation abnormalities, in conditions that preclude neuraxial blocks such as local site infections and where general anesthesia is risky in sepsis and multiorgan function disorder. It has added advantages, with better hemodynamic stability and pain management, especially in sick patients with avoidance of complications of neuraxial and general anesthesia. The surgeries were successfully carried out with ultrasound-guided combined femoral and proximal sciatic nerve blocks. All six patients obtained an adequate level of block at the area of surgery. There were no complications related to anesthetic management. Patients remained hemodynamically stable and pain-free during surgery and postoperatively. The perineural catheters were an added advantage for postoperative analgesia and repeated debridement required in these patients.
Puntambekar et al. (Sun,) studied this question.