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Abstract

Lower limb amputation in high-risk patients presents with numerous anesthetic concerns because of the patient’s multimorbidity and poor physiological state. This case series aims to discuss the ways of performing regional anesthesia (RA) techniques as a safer alternative to general anesthesia. We report five high-risk patients for lower limb amputations with individual RA techniques applied, such as sciatic nerve blockade, femoral nerve blockade, ankle blockade, epidural catheter, and caudal epidural anesthesia. Comorbidities were acute severe cardiac diseases, diabetes, chronic kidney disease, and other significant illnesses. Perioperative hemodynamics were evaluated, intraoperative complications encountered, and postoperative results observed. All the patients were in a stable hemodynamic state, and the number of intraoperative complications was rather low. The study established that RA offered acceptable blood loss of about 200 mL and adequate analgesia. 51 of the cases had favorable postoperative results, with 48 percent recurrent ischemia requiring additional surgery. RA approaches were found to be beneficial in anesthesia management of leg amputation in high-risk patients, improving cardiovascular stability, more site-directed analgesia, and fewer generalized adverse effects. The present study provides evidence for adopting a patient-specific RA approach to facilitate improved outcomes in similar high-risk surgical cohorts.
Abbreviations: GA: General anesthesia, LEA: Lower extremity amputation, RA: regional anesthesia, SMWA: Segmental Wall Motion Abnormalities
Keywords: Lower Limb Amputation; High-Risk Patients; Regional Anesthesia; Sciatic Nerve Block; Femoral Nerve Block; Individualized Care; Perioperative Management
Citation: Zahid MA, Jouhar S, Ali P, Kumar A. Navigating anesthetic complexity: lower limb amputation in high-risk patients - a case series. Anaesth. pain intensive care 2025;29(5):437-440. DOI: 10.35975/apic.v29i5.2862
Received: May 14, 2025; Revised: May 27, 2025; Accepted: June 10, 2025