Anesthesiology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA.
Anesthesiology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
BMJ Case Rep. 2024 Mar 19;17(3):e259987. doi: 10.1136/bcr-2024-259987.
A woman in her 40s with an ischaemic right lower limb, who was on extracorporeal membrane oxygenation (ECMO) following cardiopulmonary failure secondary to bilateral alveolar haemorrhage, was scheduled for through-knee amputation. She was under mechanical ventilation and continuous intravenous medications. Considering her significant comorbidities, peripheral nerve blocks were chosen for anaesthesia. Ultrasound-guided traditional nerve blockade techniques of the femoral and sciatic nerves were not possible because of the presence of an ECMO cannula, altered anatomy following previous surgery on the same side and inability to turn the patient to a lateral position. An ultrasound-guided trans fascia iliaca for femoral and anterior approach for sciatic were rather used to accomplish the nerve blockades. Surgery completed without any complications and with reduced postoperative outcomes such as opioid consumption, other morbidities and mortality. This report is unique as the literature on peripheral nerve block approaches for lower limb amputations in ECMO patients is sparse.
一位 40 多岁的女性，因双侧肺泡出血导致心肺衰竭后接受体外膜肺氧合（ECMO）治疗，出现右下肢缺血，拟行膝下截肢术。她处于机械通气和持续静脉药物治疗中。考虑到她的严重合并症，选择外周神经阻滞进行麻醉。由于 ECMO 插管的存在、同一侧先前手术改变的解剖结构以及无法将患者转为侧卧位，无法进行股神经和坐骨神经的超声引导传统神经阻滞技术。因此，使用超声引导的经髂筋膜股骨阻滞和前入路坐骨神经阻滞来完成神经阻滞。手术顺利完成，且术后结果（如阿片类药物消耗、其他合并症和死亡率）有所改善。这是一份独特的报告，因为有关 ECMO 患者下肢截肢术的外周神经阻滞方法的文献很少。
