TITLE:
Combined Sciatic, Femoral, and Obturator Nerve Blocks for Ankle Surgery in a Patient with Severe Pulmonary Hypertension—A Case Report
AUTHORS:
Ju Hyun Lee, Hyun Su Shin, Ki Yoon Kim, Ji Seon Jeong, Justin Sangwook Ko
KEYWORDS:
Femoral Nerve Block, Obturator Nerve Block, Sciatic Nerve Block, Severe Pulmonary Hypertension, Ultrasound-Guided
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.7 No.8,
August
15,
2017
ABSTRACT: We report a patient with severe pulmonary arterial hypertension (PAH) undergoing tibio-talo-calcaneal fusion due to Charcot joint. Despite the advancement in the management of PAH, the risks of anesthesia, surgery, and postoperative morbidity and mortality still remain high. A 46-year-old female was presented with severe PAH and end stage renal disease requiring hemodialysis three times a week. Ultrasound-guided sciatic, femoral, and obturator nerve blocks were performed with 0.5% levobupivacaine 15 ml, 10 ml, and 5 ml, respectively. All the blocks were successful, and the patient underwent uneventful anesthesia and surgery. In addition, the postoperative pain control lasted for 15 h and the patient was discharged on POD 5 without any complications. Therefore, ultrasound-guided sciatic, femoral, and obturator nerve blocks are valuable alternative to the general or neuraxial anesthesia in patients with severe pulmonary hypertension.