Ultrasound-guided fascia iliaca compartment block combined with general anesthesia for amputation in an acute myocardial infarction patient after percutaneous coronary intervention: A case report

Abstract

BACKGROUNDFascia iliaca compartment block is a technique that blocks three nerves, similar to a 3-in-1 nerve block. This block provides analgesia for patients undergoing lower limb surgery, and is a simple technique that is easy to implement. Here, we report a case of fascia iliaca compartment block in a patient with myocardial infarction who underwent emergency middle thigh amputation.CASE SUMMARYA 78-year-old female patient weighing 38 kg with gangrene and occlusive peripheral atherosclerosis of the right leg underwent an emergency middle thigh amputation. The patient had a history of hypertension, coronary heart disease, cerebral infarction, anterior wall myocardial infarction, and had recently undergone percutaneous coronary intervention consisting of coronary angiography and right coronary artery stent implantation. Considering the patient's condition, an ultrasound-guided fascia iliaca compartment block combined with general anesthesia was implemented for amputation. The fascia iliaca compartment block provided analgesia for the operation, and reduced the dosage of general anesthetics. It also alleviated adverse cardiovascular effects caused by pain stress, and ensured the safety of the patient during the perioperative period. This block also provided postoperative analgesia. The patient had a good prognosis, and was subsequently discharged from hospital.CONCLUSIONFascia iliaca compartment block provides surgical analgesia. It also alleviates adverse cardiovascular effects, and ensures patient safety during the perioperative period.

Pain management in the postoperative period of amputation surgeries: A scoping review

“…The mapping of studies demonstrates that strategies for pain control in this population are still focused on medical procedures such as neuromodulation through the implantation of catheters in peripheral nerves (Albright‐Trainer et al, 2022; Humble et al, 2018; Ling et al, 2019) or the use of analgesic drugs (Ayling et al, 2014; Borghi et al, 2010; Buvanendran et al, 2018; Hayes et al, 2004; Nikolajsen et al, 2000).…”

“…Regarding the occurrence of adverse events in the results of the studies, it was observed that most authors did not report such occurrences, but rather the use of measures in order to avoid possible effects—reducing the use of analgesics and/or anaesthetics—such as peripheral nerve block, iliac fascia compartment block (Ling et al, 2019) and popliteal nerve block compared with the use of anaesthetics, in which it was related to postoperative pneumonia and need of intensive treatments (Kim et al, 2016). An alternative with an analgesic effect is the use of oral ketamine and continuous perineural infusions of local anaesthetic to reduce opioids (Ayling et al, 2014; Buvanendran et al, 2018).…”

“…Also in this sense, it is observed that the levels of pain reported by patients undergo a variation in intensity (Borghi et al, 2010; Buvanendran et al, 2018; Kim et al, 2016), increasing (Hayes et al, 2004) or decreasing (Albright‐Trainer et al, 2022; Ling et al, 2019), in order to use less analgesics and/or anaesthetics (Ayling et al, 2014), or even not requiring its use (Ilfeld et al, 2019) based on the assessment of the scales during the implementation of these strategies.…”

Tunneled Fascia Iliaca Catheter Placement for Chronic Pain From Advanced Osteosarcoma

“…The FICB was first described by Dalens et al in 1989 as a reliable block alternative to the traditional "three-in-one" femoral nerve block, with a high degree of sensory blockade of the lumbar plexus nerves supplying the thigh [2]. The FICB has been well-documented as an anesthetic technique in case reports for hip and femoral surgeries [3][4][5]. It has also been used to control pain due to hip fractures in the geriatric population at risk of medication-or anesthetic-induced delirium [6,7].…”

Adding sufentanil to ropivacaine in pediatric brachial plexus block fails to improve analgesi a : A randomised controlled trial

“…With the development of ultrasound technology, the use of peripheral nerve blocks was becoming more common in the pediatric population. Even though ultrasound guidance could further reduce the risk of nerve injury, accidental entry into blood vessels, bleeding and other factors, the concentration or dosage of local anaesthetic drug should be carefully selected due to the small diameter of nerve bers, thin nerves, and short distance between adjacent Ranvier's node in children [1,2] . Therefore, how to prolong the analgesic time of nerve block had been widely concerned.…”