title: [Combined femoral and sciatic nerve block in a cachectic progressive systemic sclerosis case with gastrointestinal and cardiac involvement].
abstract: Scleroderma is a multisystemic disease of unknown etiology. The systemic disturbances cause difficulties in anesthesia practice. We present a successfully combined sciatic femoral block performed in a multisystemic scleroderma case who was planned for foot amputation. Combined sciatic-femoral block was planned for the patient, for whom left foot amputation was decided by the Orthopedics Department, with related physical weakness, probable difficult airway, and accompanying cardiac and pulmonary diseases. Following the required preoperative evaluation, sciatic and femoral block was performed with a total 15 ml volume consisting of 3 ml levobupivacaine 7.5% and 1 ml lidocaine 2% added to 11 ml NaCl 0.09% subsequently. Additional analgesic treatment was not required perioperatively, and the patient was hemodynamically stable. Tramadol infusion was applied with Patient Controlled Analgesia device at the 8th hour. The patient was discharged on the postoperative 10th day. We think that in high-risk severe cachectic systemic scleroderma cases, general anesthesia and central blocks are contraindicated. If gastrointestinal and cardiac involvements are present, as in our case, combined femoral-sciatic block may be considered as an alternative anesthetic technique.
authors.affiliation: Department of Anaesthesiology and Reanimation, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey. beritceylan@hotmail.com
authors.forename: Berit Gökçe
authors.initials: BG
authors.lastname: Ceylan
authors.forename: Sinem
authors.initials: S
authors.lastname: Sarı Ak
authors.forename: Ozlem
authors.initials: O
authors.lastname: Ozorak
authors.forename: Lütfi
authors.initials: L
authors.lastname: Yavuz
authors.forename: Füsun
authors.initials: F
authors.lastname: Eroğlu
mesh_terms: D000671:Amputation, Surgical; D000768:Anesthesia, General; D000075202:Contraindications; D005260:Female; D005267:Femoral Nerve; D005528:Foot / Q000601:surgery*; D005767:Gastrointestinal Diseases / Q000150:complications / Q000188:drug therapy; D006331:Heart Diseases / Q000150:complications / Q000188:drug therapy; D006801:Humans; D008875:Middle Aged; D009407:Nerve Block; D012584:Sciatic Nerve; D012595:Scleroderma, Systemic / Q000150:complications / Q000188:drug therapy*