Management Anesthesia of Lumbar Plexus Block and Sacral Plexus Block for Hip Disarticulation Due to ALI Rutherford IIB with Severe Cardiac and Pulmonary Problems

Abstract

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).