Article Text

Download PDFPDF
Peripheral nerve blocks for through-knee amputation in a patient on extracorporeal membrane oxygenation
  1. Nicholas Seidler1,
  2. Olivia Terlep1 and
  3. Vendhan Ramanujam1,2
  1. 1Anesthesiology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
  2. 2Anesthesiology, Lifespan Physician Group Services, Providence, Rhode Island, USA
  1. Correspondence to Dr Vendhan Ramanujam; vcramanuj{at}


A woman in her 40s with an ischaemic right lower limb, who was on extracorporeal membrane oxygenation (ECMO) following cardiopulmonary failure secondary to bilateral alveolar haemorrhage, was scheduled for through-knee amputation. She was under mechanical ventilation and continuous intravenous medications. Considering her significant comorbidities, peripheral nerve blocks were chosen for anaesthesia. Ultrasound-guided traditional nerve blockade techniques of the femoral and sciatic nerves were not possible because of the presence of an ECMO cannula, altered anatomy following previous surgery on the same side and inability to turn the patient to a lateral position. An ultrasound-guided trans fascia iliaca for femoral and anterior approach for sciatic were rather used to accomplish the nerve blockades. Surgery completed without any complications and with reduced postoperative outcomes such as opioid consumption, other morbidities and mortality. This report is unique as the literature on peripheral nerve block approaches for lower limb amputations in ECMO patients is sparse.

  • Anaesthesia
  • Pain
  • Surgery
  • Vascular surgery

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors NS, OT and VR were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content. VR gave final approval of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.