# Ultrasound-Guided Peripheral Nerve Block for Emergency Below-Knee Amputation in a High-Risk Patient With Coagulopathy: A Case Report

## TL;DR

This case report shows how ultrasound-guided nerve blocks can safely provide anesthesia for a high-risk patient needing emergency amputation.

## Contribution

The novel use of ultrasound-guided peripheral nerve blocks in a coagulopathic patient for emergency surgery is highlighted.

## Key findings

- Ultrasound-guided peripheral nerve blocks provided effective anesthesia during emergency below-knee amputation.
- The method avoided bleeding complications and hemodynamic instability in a high-risk patient.
- This approach is a safer alternative to general or neuraxial anesthesia in coagulopathic patients.

## Abstract

Emergency below-knee amputation (BKA) in patients with significant comorbidities and coagulopathy presents formidable anesthetic challenges, as a central neuraxial blockade and general anesthesia are frequently contraindicated. We report the case of a 57-year-old female patient with uncontrolled diabetes mellitus, chronic kidney disease, coronary artery disease, and an elevated international normalized ratio (INR) of 1.6, necessitating urgent BKA for a septic diabetic foot ulcer. Ultrasound-guided peripheral nerve blocks (PNBs, popliteal sciatic and femoral) have been successfully employed to achieve effective intraoperative anesthesia and postoperative analgesia without bleeding complications or hemodynamic instability. This case underscores the safety and efficacy of ultrasound-guided PNBs as the preferred anesthetic strategy in high-risk patients with coagulopathy, offering a safer alternative to conventional methods and minimizing perioperative morbidity.