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Sole regional anaesthetic technique for a through knee amputation in a patient with spina bifida

Khafaga M

Introduction: A 44-year-old lady with a history of spina bifida, chronic renal failure and grade 4 intubation needing an awake fiber-optic presented for a through knee amputation. A decision was taken to follow a sole regional anaesthetic and postoperative analgesia plan. Methods: Femoral block: Lateral approach in plane technique was adopted and 10 ml of chiroccaine 0.5% added to 10 ml of lignocaine 1% were injected to completely surround the femoral nerve. Sciatic sub gluteal block: Lateral approach in plane technique was adopted and 10 ml of chiroccaine 0.5% added to 10 ml of lignocaine 1% were injected to completely surround the sciatic nerve. Adductor canal block: Lateral approach in plane technique was adopted and 10 ml of chiroccaine 0.5% added to 10 ml of lignocaine 1% were injected to completely surround the femoral artery in the adductor canal. Discussion: In view of the multiple comorbidities including the spina bifida, the renal disease and the history of difficult airway management, we decided to perform a sole regional anaesthetic technique for intraoperative and postoperative analgesia. The patient already had a patchy sensation over the lower limbs due to her neurological condition, which was another factor in favour of the choice of the anaesthetic plan. The operation was safely performed with the patient being very comfortable without needing any further sedation. Conclusion: Sole regional anaesthetic techniques could be used successfully for lower limb surgeries in patients suffering from Spina Bifida.