CONTINUOUS SPINAL ANAESTHESIA WITH POPLITEAL SCIATIC NERVE BLOCK FOR BELOW KNEE AMPUTATION IN A PATIENT WITH MULTIPLE COMORBIDITIES FOR EARLY REHABILITATION

Abstract

A male patient in his late fifties, with a history of coronary artery disease, chronic kidney disease, and sepsis, required below knee amputation under tourniquet. Due to a heart rate of 110/minute, blood pressure of 90/60 mm Hg, and noradrenaline support, along with elevated creatinine levels and moderate systolic dysfunction, the patient's perioperative management was challenging. To decrease risks, continuous spinal anaesthesia (CSA) at a low dose (0.5ml of bupivacaine) was combined with a popliteal sciatic nerve block. CSA provided effective anaesthesia with minimal hemodynamic fluctuations, ensuring a stable intraoperative course. The addition of a popliteal sciatic nerve block aimed to enhance early postoperative pain management. The patient maintained hemodynamic stability without anaesthesia-related complications. However, postoperatively, after two days recurrent pulmonary oedema ensued, necessitating dialysis, diuretics, and non-invasive ventilation. CSA demonstrated superiority over general anaesthesia for high-risk patients, offering improved cardiovascular stability and faster recovery. This faster recovery ensured early rehabilitation and physiotherapy