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MAJOR LOWER EXTREMITY AMPUTATION WITH PERIPHERAL NERVE BLOCKS IN HIGH RISK PATIENTS
Author(s): ,
Beh , Z.Y.
Affiliations:
Changi General Hospital, Anaesthesia & Surgical Intensive Care, Singapore, Singapore
,
Rajkumar , C.
Affiliations:
Changi General Hospital, Anaesthesia & Surgical Intensive Care, Singapore, Singapore
,
Tsai , F.C.*
Affiliations:
Changi General Hospital, Anaesthesia & Surgical Intensive Care, Singapore, Singapore
,
Lim , J.Y.
Affiliations:
Changi General Hospital, Anaesthesia & Surgical Intensive Care, Singapore, Singapore
Kuruppu , S.D.
Affiliations:
Changi General Hospital, Anaesthesia & Surgical Intensive Care, Singapore, Singapore
ESRA Academy. Tsai F. Sep 13, 2017; 190886
Topic: REGIONAL ANAESTHESIA (RA) IN SPECIFIC SUBPOPULATIONS
Dr. Fung Chen Tsai
Dr. Fung Chen Tsai

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Abstract
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Background and Aims:

Major lower extremity amputation (MLEA) is associated with considerable mortality and morbidity. Studies have shown mortality benefits of using regional anaesthesia techniques. However the effects of peripheral nerve blocks (PNB) as the sole anaesthetic technique in high risk patients undergoing MLEA have not been fully evaluated. We evaluate the use of PNB in the study population, patient outcome and predictive factors of mortality.

Methods:

This is a retrospective cohort study.  We evaluated 68 high risk cases from a total of 150 cases underwent non traumatic MLEA using PNB in between January 2010 till December 2014. Outcomes measured: success of the operation, block details, intraoperative haemodynamics, usage of sedation and analgesia, major comorbidities, mortality rates at 30 days and 1 year

Results:

Out of 68 cases, 99% (67) ASA IV, 68% (46) males and median age (IQR [range]) was 70 (59.5 – 80 [38 – 97]) years. 53% (36) had AKA and 47% (32) had BKA. 93% successfully underwent surgery with PNB. 90% required intra-operative sedation and analgesia. AKA group required higher sedation and analgesia compared to the BKA group (p = 0.038). In the AKA group, 50% received combined femoral, obturator and sciatic nerve blocks and another 50% had combined femoral and sciatic nerve (FS) blocks. 94% had FS blocks in the BKA group. The 30-day and 1 year mortality was 8.8% & 33%.

Conclusions:

PNB can be used as the sole anesthetic technique in high risk patients having MLEA. Mortality rates were lower to those reported in literature.

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