Unilateral spinal anesthesia with hypobaric bupivacaine for regularization of the right lower limb amputation stump: a case report with video

Abstract

Background: Patients with poorly controlled diabetes mellitus have an increased risk of lower limb amputation (LEA), being is associated with a high risk of postoperative mortality. Several studies have shown that the type of anesthesia did not significantly affect mortality or morbidity after LEA. In a literature search, no study was found comparing general anesthesia and unilateral spinal anesthesia. We will show a case of a patient, operated under unilateral spinal anesthesia with 5 mg of 0.15% hypobaric bupivacaine, in left lateral decubitus to regularize the stump of an amputation of the right lower limb. Case report: Woman aged 70 years, 66 kg, 160 cm, physical status ASA III, with type I diabetes controlled with insulin and systemic arterial hypertension. Patient underwent amputation two months ago and admitted for regularization of the stump of the amputation. Laboratory tests and chest X-ray and ECG were normal. After signing the informed consent form and a detailed explanation of the anesthetic technique for the patient and her family, and unilateral spinal anesthesia with hypobaric bupivacaine solution is being proposed. Routine monitoring and venoclysis with a 20G catheter. Abbreviation for CHO fasting. Sedation with 50 μg of fentanyl and 1 mg of midazolam. In left lateral decubitus, the L3-L4 interspace was punctured with 27G Quincke and after the appearance of CSF, 5 mg of 0.15% hypobaric bupivacaine was injected, remaining in this position for 10 minutes. The sensory and motor blockade was restricted to the limb to be operated and the patient was placed in the supine position for the surgical procedure. The procedure lasted 40 minutes and was taken to the PACU, and after 200 ml CHO and the end of the block, she was taken to the room. Conclusion: The technique provided great cardiocirculatory stability and patient satisfaction as there was no degree of blockage in the contralateral limb. Discharged from hospital on the 2nd postoperative day.