Ultrasound guided popliteal sciatic block combined with femoral nerve block for managing a high risk patient on Apixaban for I&D of foot abscess
Author(s): ,
gnanamuttu, A.*
Queen's hospital- Burton, anaesthetics, Burton upon Trent, United Kingdom
haldar, M.
Queen hospital- Burton, anaesthetics, Burton upon Trent, United Kingdom
ESRA Academy. Gnanamuttu A. Sep 13, 2017; 190943; 510
Dr. Anush Gnanamuttu
Dr. Anush Gnanamuttu

Access to Premium content is currently a membership benefit.

Click here to join ESRA or renew your membership.

Discussion Forum (0)
Rate & Comment (0)
Background and Aims:

Current guidance is to avoid peripheral nerve blocks in the presence of anticoagulation. However in certain situations, where the risks of alternative techniques are high, then it may be appropriate to perform these blocks in the presence of anticoagulation. Here we present our management of a high risk anticoagulated patient who presented for incision and drainage of abscess using peripheral nerve blocks alone.


 We were asked to pre-assess a 89 year old patient posted for I&D of an absess of the foot. He had been admitted to hospital following falls and increased confusion and known to have COPD, hypertension, atrial fibrillation for which he was on apixaban and congestive cardiac failure. His exercise tolerance was only 10 yards and saturations were 87% on air.


Ultrasound guided popliteal sciatic nerve and saphenous nerve block at the level of knee was performed. After 25 minutes there was almost complete motor block and surgery performed without any complications. There were no complications to report.


Peripheral nerve blocks in the presence of anticoagulation can be associated with complications. Most of these have been associated with deep blocks or with peripheral nerve catheters. If the risks for alternative techniques are high, then on a relative risk basis, there may be role for peripheral nerve blocks in the presence of anticoagulation. The use of ultrasound guidance, helps avoid injury to vascular structures, which might cause nerve injury through haematoma formation.

Code of conduct/disclaimer available in General Terms & Conditions
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.

Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.

Google Analytics is used for user behavior tracking/reporting. Google Analytics works in parallel and independently from MLG’s features. Google Analytics relies on cookies and these cookies can be used by Google to track users across different platforms/services.

Save Settings