Continuous femoral nerve block provides a practical advantage over epidural anesthesia for postoperative analgesia in HOCM patients undergoing noncardiac surgery, allowing for management of complications like pulmonary edema without interrupting pain control.
May permit uninterrupted analgesia during pulmonary edema management in HOCM patients; hypothesis-generating for continuous femoral nerve block and needs confirmation.
This case report exemplifies how the anaesthetic technique of general anesthesia with continuous bilateral femoral nerve block for bilateral knee arthroplasty was well chosen for the management of perioperative complications in an elderly patient with hypertrophic obstructive cardiomyopathy (HOCM). A 69-year-old female patient of HOCM was scheduled for bilateral total knee replacement. Echocardiography revealed severe left ventricular outflow tract obstruction with peak systolic gradient of 56 mmHg. The surgery was conducted under general anaesthesia with invasive monitoring and bilateral continuous femoral nerve blocks for postoperative analgesia. Postoperatively, she developed pulmonary oedema due to the liberal administration of fluids. This complication was successfully managed without interrupting the management of pain. Management of patients with HOCM for noncardiac surgery requires knowledge of variable presentation of two forms of disease. Also, this case report highlights the practical advantage of continuous femoral nerve block (CFNB)s over epidural anaesthesia.
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Rupal et al. (2013) studied this question.
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