Anesthesia for leg amputation in high risk patients: Case reports

Background: High risk cases of leg amputation were one of major concerns in anesthesiologists.　 Cases: Sixteen cases with American Society of Anesthesiologists physical status (ASA-PS) 3 or 4 for leg amputation were reported.  Fifteen patients were medicated with more than two anticoagulants and 11 patients had bleeding tendency.  Thirteen patients received below knee amputation (BKA) and three patients received above knee amputation (AKA).  Twelve patients received sciatic and femoral nerve blocks using ropivacaine and lidocaine then intravenous fentanyl and/or midazolam, and four received general anesthesia with inhalation anesthetics.  Vasopressors were administered in 3/12 patients anesthetized by blocks and all patients by general anesthesia.  Heart rate increased to more than 120 beats/min during surgery in all cases in general anesthesia.  VAS scores in postoperative 12 hours after surgery was 0 to 3 in patients anesthetized with blocks and 4 to 7 in patients with general anesthesia.  Phantom pain might be less in blocks.   Conclusions: Femoral and sciatic nerve blocks with small dose of fentanyl and/or midazolam seemed to be better than general anesthesia in terms of hemodynamics during surgery and postoperative analgesia.