Key result
Combined lumbar and sacral plexus blocks maintain stable hemodynamics and provide ~15-hour pain control in hip disarticulation.
Why the study?
Acute limb ischemia is a vascular emergency associated with a high risk of limb loss and death, requiring specialized anesthesia management during hip disarticulation in patients with severe cardiac and pulmonary comorbidities.
Does combined lumbar plexus block and sacral plexus block provide effective anesthesia, hemodynamic stability, and postoperative analgesia in a high-risk patient with Rutherford IIB acute limb ischemia and severe cardiopulmonary comorbidities undergoing hip disarticulation?
Case Report (n=1)
No
Does combined lumbar plexus block and sacral plexus block provide effective anesthesia, hemodynamic stability, and postoperative analgesia in a high-risk patient with Rutherford IIB acute limb ischemia and severe cardiopulmonary comorbidities undergoing hip disarticulation?
Combined lumbar plexus and sacral plexus blocks can provide effective perioperative anesthesia and hemodynamic stability for major lower extremity amputation in critically ill patients with severe heart failure (LVEF 24%) and acute limb ischemia.
Answers are grounded in this paper and cite their sources.
May support combined plexus blocks in high-risk hip disarticulation; hypothesis-generating and requires prospective validation before practice change.
Background : Acute limb ischemia (ALI) is a vascular emergency associated with a high risk for limb loss and death. Peripheral artery disease is responsible for 12 to 15% of deaths in Europe. The spectrum ranges from asymptomatic or intermittent claudication to necrosis and limb loss2. Case Illustration : A 68 year old man with a diagnosis of Rutherford IIB acute limb ischemia (ALI) in the left leg presented with complaints of blackening extending to the upper lower extremity. The patient was admitted to the cardiac HCU with a diagnosis of low EF 24%, severe segmental kinetic disorder, LV apical thrombus, LV sec, grade 3 pulmonary edema, pulmonary consolidation sinistra, pneumonia dextra and sepsis. The patient was scheduled for left hip disarticulation. Anesthesia management involved a lumbar plexus block with isobaric bupivacaine 0.5% 20 mL (100 mg) and a sacral plexus block with isobaric bupivacaine 0.5% 15 mL (75 mg). After the hip disarticulation procedure, the patient desaturation until 88%, suplementation oksigen with non rebreathing mask (NRM) at 15 lpm, improving to 95%. The patient was admitted to the ICU. In the ICU, the saturation was 90% with NRM at 15 lpm, so non invasive ventilation (NIV) was used with a pressure support of 5, PEEP of 5 and FiO2 of 100%. The patient also hypoglycemia (23 g/dl). After evaluation with GDS and weaning off NIV, the patient was transferred to the ward with a Numeric Rating Score (NRS) of 1-2. Conclusion : The operation lasted for 3 hours with no pain during the procedure and stable vital signs monitoring. Pain evaluation after the operation showed a score of 1-2 using the Numeric Rating Score (NRS).
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Akhiruddin et al. (2026) conducted a case report in Rutherford grade IIB acute limb ischemia undergoing hip disarticulation with severe cardiac and pulmonary comorbidities (EF 24%, grade 3 pulmonary edema, pneumonia, sepsis) (n=1). Ultrasound-guided lumbar plexus block and sacral plexus block with isobaric bupivacaine was evaluated on Postoperative pain on the Numeric Rating Scale (NRS) and intraoperative hemodynamic stability. Combined lumbar and sacral plexus blocks with 0.5% bupivacaine maintained stable vital signs during a 3-hour hip disarticulation and achieved a postoperative NRS pain score of 1-2 for 15 hours.
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