Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Brief Communication
Cardiac Critical Care, Case Report
Cardiac Critical Care, Case Series
Cardiac Critical Care, Editorial
Cardiac Critical Care, Invited Editorial
Cardiac Critical Care, Original Article
Cardiac Critical Care, Point of Technique
Cardiac Critical Care, Review Article
Case Report
Case Report, Cardiac Critical Care
Case Series, Cardiac Critical Care
Editorial
Editorial, Cardiac Critical Care
Invited Editorial, Cardiac Critical Care
JCCC Quiz, Cardiac Critical Care
Legends in Cardiac Sciences
Letter To Editor Response
Letter to Editor, Cardiac Anesthesia
Letter to Editor, Cardiac Critical Care
Letter to the Editor
Narrative Review, Cardiac Critical Care
Original Article
Original Article, Cardiac Critical Care
Original Article, Cardiology
Perspective Insights
Perspective, Cardiac Critical Care
Point of Technique
Point of Technique, Cardiac Critical Care
Point of View, Cardiac Critical Care
Review Article
Review Article, Cardiac Critical Care
Review Article, Cardiology
Review Article, Evidence Based Medicine
Review Article, Invited
Short Communication, Cardiac Critical Care
Surgical Technique
Surgical Technique, Cardiology
Systematic Review
Technical Note
Video Case Report
Video Commentary
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Brief Communication
Cardiac Critical Care, Case Report
Cardiac Critical Care, Case Series
Cardiac Critical Care, Editorial
Cardiac Critical Care, Invited Editorial
Cardiac Critical Care, Original Article
Cardiac Critical Care, Point of Technique
Cardiac Critical Care, Review Article
Case Report
Case Report, Cardiac Critical Care
Case Series, Cardiac Critical Care
Editorial
Editorial, Cardiac Critical Care
Invited Editorial, Cardiac Critical Care
JCCC Quiz, Cardiac Critical Care
Legends in Cardiac Sciences
Letter To Editor Response
Letter to Editor, Cardiac Anesthesia
Letter to Editor, Cardiac Critical Care
Letter to the Editor
Narrative Review, Cardiac Critical Care
Original Article
Original Article, Cardiac Critical Care
Original Article, Cardiology
Perspective Insights
Perspective, Cardiac Critical Care
Point of Technique
Point of Technique, Cardiac Critical Care
Point of View, Cardiac Critical Care
Review Article
Review Article, Cardiac Critical Care
Review Article, Cardiology
Review Article, Evidence Based Medicine
Review Article, Invited
Short Communication, Cardiac Critical Care
Surgical Technique
Surgical Technique, Cardiology
Systematic Review
Technical Note
Video Case Report
Video Commentary
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Brief Communication
Cardiac Critical Care, Case Report
Cardiac Critical Care, Case Series
Cardiac Critical Care, Editorial
Cardiac Critical Care, Invited Editorial
Cardiac Critical Care, Original Article
Cardiac Critical Care, Point of Technique
Cardiac Critical Care, Review Article
Case Report
Case Report, Cardiac Critical Care
Case Series, Cardiac Critical Care
Editorial
Editorial, Cardiac Critical Care
Invited Editorial, Cardiac Critical Care
JCCC Quiz, Cardiac Critical Care
Legends in Cardiac Sciences
Letter To Editor Response
Letter to Editor, Cardiac Anesthesia
Letter to Editor, Cardiac Critical Care
Letter to the Editor
Narrative Review, Cardiac Critical Care
Original Article
Original Article, Cardiac Critical Care
Original Article, Cardiology
Perspective Insights
Perspective, Cardiac Critical Care
Point of Technique
Point of Technique, Cardiac Critical Care
Point of View, Cardiac Critical Care
Review Article
Review Article, Cardiac Critical Care
Review Article, Cardiology
Review Article, Evidence Based Medicine
Review Article, Invited
Short Communication, Cardiac Critical Care
Surgical Technique
Surgical Technique, Cardiology
Systematic Review
Technical Note
Video Case Report
Video Commentary
View/Download PDF

Translate this page into:

Short Communication
Cardiac Critical Care
7 (
2
); 111-112
doi:
10.25259/JCCC_10_2023

Femoral Nerve Block for Emergency Femoral Artery Saddle Embolectomy

Department of Cardiac Anaesthesia and Critical Care, AIIMS, New Delhi, India
Department of Cardiac Anaesthesia and Critical Care, AIIMS Hospital, New Delhi, India
Corresponding author: Sambhunath Das, Department of Cardiac Anaesthesia and Critical Care, AIIMS Hospital, New Delhi, India. sambhunathds833@gmail.com
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Singh R, Das S. Femoral nerve block for emergency femoral artery saddle embolectomy. J Card Crit Care TSS 2023;7:111-2.

A 38-year-old female was diagnosed with a case of severe mitral stenosis with atrial fibrillation and with a left atrial (LA) clot. The patient was admitted for mitral valve replacement and LA clot removal. In the pre-operative period, the patient suddenly complained of weakness and coldness in both the lower limbs. Arterial and Venous Doppler revealed acute thrombosis of abdominal aorta after the origin of the inferior mesenteric artery extending into bilateral common iliac artery with monophasic flow [Figure 1] in bilateral common femoral artery, superficial femoral artery, and popliteal artery. Diagnosis of acute limb ischemia was confirmed and patient was posted for emergency saddle thrombectomy. In view of acute vascular ischemia and paraparesis and severe pain, femoral embolectomy was planned under regional anesthesia in the form of an ultrasound-guided femoral nerve block. Anti-aspiration prophylaxis was administered to the patient. Her prothrombin time and international normalized ratio were 20 s was 1.6, respectively.

Figure 1:
Schematic diagram of monophasic Doppler flow pattern due to femoral artery embolus.

The procedure for the femoral nerve block was explained to the patient in her language. Bilateral inguinal regions were painted with betadine and covered with sterile drapes. M turbo Sonosite machine with a linear probe of frequency of 5–10 MHz was selected for visualization of femoral nerve anatomy. Probe was placed just below the inguinal crease and the femoral vein, artery, and nerve bundle were appreciated from medial to lateral [Figure 2]. Once the femoral nerve bundle was localized, a block needle was inserted using in plain approach. The needle tip was visualized in the femoral nerve bundle, after that hydro dissection was achieved with 1–2 mL of saline. Fifteen mL of 0.375% ropivacaine was injected into the femoral nerve plain. The same procedure of nerve block was repeated on the other side. After 10–15 min, surgery was started. The patient did not complain of any pain during the procedure. Hemodynamic parameters were stable throughout the procedure. The total operative time was 1.5 h. Immediately following the embolectomy, her limbs became warm and distal pulsation became palpable with normal biphasic flow [Figure 3]. The patient was shifted to the recovery area. There were no signs of residual motor weakness in the lower limbs.

Figure 2:
Ultra sonographic image of femoral nerve block. V: Femoral vein, A: Femoral artery, N: Femoral nerve.
Figure 3:
Ultra sonographic image of biphasic flow pattern of normal blood flow in femoral artery after embolectomy.

The dislodgment and migration of LA clots to abdominal, femoral, and peripheral arteries including stroke is an emergency.[1] Immediate embolectomy is life-saving by re-establishing perfusion. Femoral nerve [Figure 4] block anesthesia is a possible technique for embolectomy from the femoral artery approach.[2] It will avoid the use of general anesthesia and neurological assessment can be performed during embolectomy. The patient will have complete analgesia, quick mobility, and vasodilatation effect due to sympathetic nerve block compared to GA. Hence, monitored anesthesia care with bilateral femoral nerve block is an alternative method of anesthesia for saddle embolectomy.

Figure 4:
Anatomical relationship of femoral vein, and femoral nerve at the groin. (1: Femoral Vein, 2: Femoral Artery and 3: Femoral Nerve).

Declaration of patient consent

Patient’s consent not required as there are no patients in this study.

Conflicts of interest

There are no conflicts of interest.

Financial support and sponsorship

Nil.

References

  1. , , , , . Diagnosis and treatment of aortic saddle embolism. Ann Vasc Surg. 2018;56:124-31.
    [CrossRef] [PubMed] [Google Scholar]
  2. , , . Femoral nerve blockade. Med Ultrason. 2010;12:139-44.
    [Google Scholar]

Fulltext Views
728

PDF downloads
359
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections