Ultrasound-Guided Peripheral Nerve Block as the Sole Anesthetic for Above-Knee Amputation in a Patient With Severe Cardiopulmonary Comorbidities

Above-knee amputation (AKA) carries substantial perioperative risk in patients with advanced cardiopulmonary disease for whom general and neuraxial anesthesia are poorly tolerated. Data supporting peripheral nerve blocks (PNBs) as the primary intraoperative anesthetic remain limited. We present a 79-year-old male with extensive cardiopulmonary and metabolic comorbidities who underwent left AKA for chronic limb-threatening ischemia. Ultrasound-guided sciatic, femoral, obturator, and lateral femoral cutaneous nerve blocks using ropivacaine were performed as the sole anesthetic with intravenous midazolam, achieving complete anesthesia without hemodynamic compromise. The Visual Analog Scale score was 0 postoperatively. The technique was reproduced successfully for contralateral amputation, reinforcing the role of PNBs as a primary anesthetic strategy in high-risk patients.