51st Annual Regional Anesthesiology and Acute Pain Medicine Meeting

Analgesia for Above-Knee Amputation Debridement:

Utility of a Suprainguinal Fascia Iliaca Plane Catheter
Abbie Chase, MD; Stephanie Amaefuna MD, MPH; Nikhil Mikkilineni, MD

When infection, dressings, or anticoagulation limit traditional regional or neuraxial techniques in patients with proximal lower-extremity amputation, a continuous suprainguinal fascia iliaca plane (SIFIP) catheter can provide analgesia, reduce opioid requirements, facilitate bedside wound care, and decrease operating room utilization.

Case Description:

•65 y/o man, PMHx DMII, HTN, PAD s/p R AKA 3 mos prior

•Presented requiring surgical debridement of AKA wound (Figure 1)

•Post-op pain refractory to hydromorphone PCA

•Unable to tolerate dressing changes

•Neuraxial contraindicated d/t SQH administration

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Intervention

•Right Suprainguinal Fascia Iliaca Plane Catheter tunneled away from wound site (Figure 2)

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Result:

•Able to tolerate bedside dressing and wound vacuum changes

•Decreased trips to OR reduced cost and patient exposure to general anesthesia

•No nerve catheter infection

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Discussion:

•Serial lower extremity amputations progress proximally limiting regional anesthesia options

•Fascia iliaca plane blocks provide analgesia when adductor canal or femoral sites are inaccessible

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•Proximity of large wounds may increase risk of nerve catheter-associated infections

•Tunneling removes nerve catheters from sources of infection

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•Careful evaluation for regional anesthesia opportunities remains essential in patients with progressive limb loss.

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Author Affiliations:

Boston Medical center, Department of Anesthesiology

Boston University Chobanian & Avedisian School of Medicine

Disclosures: None

51st Annual Regional Anesthesiology and Acute Pain Medicine Meeting

Analgesia for Above-Knee Amputation Debridement: Utility of a Suprainguinal Fascia Iliaca Plane Catheter

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