This video demonstrates the combined femoral and sciatic nerve blocks in patients undergoing major lower extremity amputations (MLEA), such as aboveknee (AKA) or belowknee (BKA) amputations. These patients often have multiple comorbidities, including diabetes, cardiovascular, and renal disorders, making them poor candidates for general, and sometimes even spinal anesthesia due to heightened risks of postoperative complications, and/or risk of spinal hematoma. In the video, we combined these blocks with liposomal bupivacaine (Exparel®) to extend the analgesic benefits even much longer into the postoperative period, as documented in a study by Schwartz and colleagues.
Here are the Key Insights from the Video:
1. High Mortality Rates PostMLEA: Research shows a 20% mortality rate within 30 days and nearly 50% within a year following MLEA. Our techniques aim to mitigate these risks.
2. Objective of Anesthetic Management: We focus on minimizing anesthetic risks while providing effective postoperative analgesia. This approach not only alleviates patient suffering but also promotes early mobilization.
3. Benefits of Combined Nerve Blocks: The use of subgluteal sciatic and femoral nerve blocks during surgeries for lower extremity amputation maintains stable hemodynamics and reduces the risk of intraoperative and postoperative morbidity.
4. Enhancement with Exparel: We incorporate Exparel in approved indications for sciatic and femoral blocks, optimizing anesthesia and improving outcomes for our most vulnerable patients.


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