J Korean Orthop Assoc.  2018 Oct;53(5):435-442. 10.4055/jkoa.2018.53.5.435.

Ultrasound-Guided Regional Nerve Block in Below-Knee Amputation

• Song JH
• Kang C
• Hwang DS
• Kang DH
• Yoo CH

• KMID: 2424103
• DOI: http://doi.org/10.4055/jkoa.2018.53.5.435

Abstract

PURPOSE
This study compared the clinical results of an ultrasound (US)-guided regional nerve block with those of general anesthesia in below-knee amputation (BKA) surgery. In addition, the 1-year mortality rate of BKA patients was evaluated in relation to the preoperative comorbidity and postoperative hemoglobin level.
MATERIALS AND METHODS
Among 47 patients who underwent BKA between January 2011 and August 2016, 18 patients in the US-guided regional nerve block group (group 1) and 29 patients in the general anesthesia group (group 2) were analyzed retrospectively and compared. For the clinical assessment, the 30-day mortality, 1-year mortality, postoperative hemoglobin level, and postoperative complications of both groups were investigated. The visual analogue scale (VAS) pain scores at postoperative 1, 6, and 12 hours for both groups were evaluated. The 1-year mortality of BKA patients was also evaluated in relation to the preoperative comorbidity and postoperative hemoglobin level (hemoglobin < 7 g/dl).
RESULTS
Significant differences in the 30-day mortality were observed between the two groups (p=0.023). Group 1 showed a higher 30-day mortality but the 1-year mortality was similar in both groups (p=0.051). The postoperative hemoglobin level was similar in the two groups (p=0.085). The VAS pain scores for the postoperative 1-hour and 6-hour differed significantly between the two groups (p < 0.001). The VAS pain scores for postoperative 12-hour showed no significant difference (p=0.10). The 1-year mortality rate of both groups was not affected by hypertension, diabetes mellitus, arteriosclerosis obliterans, and postoperative hemoglobin less than 7 g/dl, but was affected by chronic kidney disease (CKD) (Pearson's chi-square=14.39, p < 0.05).
CONCLUSION
Although US-guided regional nerve block showed comparable 1-year mortality and postoperative hemoglobin levels compared to general anesthesia in BKA, it showed better results in postoperative 1, 6 hour pain control than general anesthesia. The 1-year mortality of BKA was affected by CKD. Therefore, careful consideration is needed for patients with CKD before undergoing BKA regardless of the anesthetic methods.

Keyword

amputation; nerve block; general anesthesia; mortality; comorbidity

MeSH Terms

Amputation*
Anesthesia, General
Arteriosclerosis Obliterans
Comorbidity
Diabetes Mellitus
Humans
Hypertension
Mortality
Nerve Block*
Postoperative Complications
Renal Insufficiency, Chronic
Retrospective Studies
Ultrasonography

Figure

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  Figure 1 Ultrasound images of the lateral femoral cutaneous nerve (A), femoral nerve (B), sciatic nerve (C), posterior femoral cutaneous nerve (D) are shown. The dotted circles indicate the injected nerve with a spinal needle that is also indicated by the white arrows.

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  Figure 2 (A) A 66-year-old female diagnosed with arteriosclerosis obliterans had an acute ischemic gangrenous change in her right foot. (B) Below-knee amputation was performed in emergency under an ultrasound-guided nerve block.

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