Case study: Peripheral nerve blocks for pain management in a diabetic patient with foot gangrene
A 69-year-old patient, 156 cm tall, weighing 90 kg, with a long history of diabetes mellitus, presented with foot gangrene and was scheduled for wound debridement and potential amputation. The patient’s hemodynamic status was stable, and no signs of systemic infection were observed. Relevant medications included insulin and low-molecular-weight heparin, which had been discontinued 48 hours prior to the procedure. Airway assessment indicated Mallampati Class 2 (MP 2).
The patient’s hemodynamic stability and absence of systemic infection allowed for the consideration of general anesthesia. However, postoperative pain management posed a challenge due to the potential need for opioids and associated risks. To mitigate these risks, the utilization of peripheral nerve blocks was explored as an alternative approach.
Specifically, a popliteal block with 20 mL ropivacaine 0.5% and a femoral triangle block for saphenous nerve territory coverage using 5 mL of ropivacaine 0.5% were performed, allowing for effective pain management and avoiding airway instrumentation, intubation, and mechanical ventilation.
The combination of the popliteal block and femoral triangle block resulted in complete pain management for 24+ hours. By utilizing nerve blocks, prolonged pain relief can be achieved, reducing the reliance on systemic opioids and lowering associated risks.
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