CASE REPORT
APPLICATION OF ULTRASOUND-GUIDED FEMORAL NERVE BLOCK IN A PATIENT WITH SEVERELY IMPAIRED LEFT VENTRICULAR FUNCTION UNDERGOING FEMORO-POPLITEAL BYPASS RECONSTRUCTIVE SURGERY

UDK: 616.13-089.5

Trposka Poposka A.1, Naumovski F.1,Stojkovska Lozanovska A.1,Kokareva A1.,Andov M.2, Anastasov M2

1University Clinic for Traumatology, Orthopedics, Anesthesia, Reanimation, Intensive Care and Emergency Department – Skopje, Department for Anesthesia, Reanimation and Intensive Care

2University Clinic for Thoracic and Vascular Surgery -Skopje, Department of Vascular Surgery

Naumovski  Filiphttps://orcid.org/0009-0004-7352-8014 
 KokarevaAnitahttps://orcid.org/0000-0002-0250-5649 
Andov Mishelhttps://orcid.org/0000-0002-5263-764X

Abstract

Introduction:

Patients with severe left ventricular dysfunction undergoing major vascular surgery represent a high-risk population for perioperative morbidity and mortality. Careful anesthetic management focused on maintaining hemodynamic stability while minimizing myocardial depression is essential in such patients.

Case report:

We present the anesthetic management of an 84-year-old ASA IV patient with severely reduced left ventricular ejection fraction (35%), undergoing elective femoropopliteal bypass surgery due to critical peripheral arterial disease.The aim of this case report is to highlight the benefits of carefully titrated general anesthesia combined with an ultrasound-guided femoral nerve block and a low-dose dobutamine infusion to maintain stable hemodynamic conditions and reduce systemic opioid requirements, emphasizing an individualized anesthetic approach in a patient with complex cardiovascular and renal comorbidities.The block was performed using an in-plane ultrasound technique with bupivacaine and lidocaine.  Throughout the entire procedure, the patient remained hemodynamically stable, without experiencing clinically significant episodes of hypotension, hypertension, arrhythmia, or tachycardia. The procedure lasted approximately 2 hours and 30 minutes and was completed without complications. The patient was extubated in the operating room, remained hemodynamically stable postoperatively, and was discharged from the hospital in stable condition.

Conclusion:
The use of peripheral nerve blocks in combination with general anesthesia may provide excellent conditions for performing complex vascular procedures in patients with cardiac comorbidities. Ultrasound-guided femoral nerve block combined with carefully titrated general anesthesia may represent a useful opioid-sparing strategy for maintaining hemodynamic stability in high-risk vascular patients with severe left ventricular dysfunction.

Keywords: Femoral nerve block; left ventricular dysfunction; opioid-sparing anesthesia; regional anesthesia; vascular surgery.

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