Year: 2026 | Month: May | Volume: 16 | Issue: 5 | Pages: 106-112
DOI: https://doi.org/10.52403/ijhsr.20260513
Ultrasound Guided Peripheral Nerve Blocks for Emergency Below Knee Amputations - A Case Series
Aswini Lakshmi Narasimhan1, Savitha Velayutham2
1Associate Professor, Department of Anesthesiology, ESIC Medical College and Hospital, Chennai, Tamil Nadu, India
2Senior Resident, Department of Anesthesiology, ESIC Medical College and Hospital, Chennai, Tamil Nadu, India
Corresponding Author: Dr. Aswini Lakshmi Narasimhan
ABSTRACT
Background: Below-knee amputation (BKA) and distal lower limb wound debridement are frequently performed in patients with diabetes, peripheral vascular disease, and multiple systemic comorbidities. These patients often carry high perioperative risk, rendering general or neuraxial anesthesia challenging. Peripheral nerve blocks (PNBs) have emerged as a safe and effective alternative anesthetic approach.
Methods: This case series included patients undergoing BKA or lower limb wound debridement in whom ultrasound-guided lower limb PNBs were used as the primary anesthetic technique. The sciatic nerve block was combined with either femoral or saphenous nerve block. Intraoperative hemodynamics, adequacy of surgical anesthesia, need for supplemental analgesia, and postoperative pain scores were prospectively recorded.
Results: All patients achieved adequate surgical anesthesia with stable intraoperative hemodynamics. PNBs provided effective perioperative and postoperative analgesia, reducing opioid requirements and enhancing patient comfort. No major complications were observed. Ultrasound guidance facilitated precise nerve localization and improved block success. Limitations included the need for technical expertise and occasional requirement for supplemental analgesia.
Conclusion: Ultrasound-guided lower limb PNBs are a safe, effective, and reliable anesthetic technique for BKA and lower limb wound debridement, offering excellent intraoperative anesthesia and postoperative analgesia. Larger prospective studies are warranted to further evaluate their efficacy and long-term outcomes.
Key words: Below-knee amputation, Peripheral nerve block, Sciatic nerve block, Femoral nerve block, Saphenous nerve block, Ultrasound guidance, Postoperative analgesia