187 Femoral branch block of genitofemoral nerve for femoral endarterectomy: a case report

Background and Aims Patients undergoing lower extremity vascular surgery are often at high risk for perioperative complications. We report a case of a high risk patient who underwent common femoral endarterectomy anesthetized by ultrasound guided femoral branch block of genitofemoral nerve (FBG) plus intravenous sedation. Methods A 64 years old female patient was scheduled for common femoral endarterectomy and patch angioplasty. She had a history of congestive heart failure after myocardial infarction and chronic obstructive pulmonary disease. She was on dialysis three times a week, had echinococcal cyst in left lung, suffering from diabetic foot and was admitted to the hospital multiple times due to deregulated CHF. She was considered as high risk patient for general anesthesia. Her international normalized ratio (INR) was 1,7 so neuraxial anesthesia was contraindicated. The FBG nerve provides sensation to the skin of the femoral triangle and to the underlying tissues and vessels within the femoral sheath. FBG nerve block was performed as a single peripheral nerve block for surgical anesthesia plus sedation. Using Mindray M7 ultrasound machine and L14-6Ns Linear transducer, the needle was inserted in plane to the sheath and 15 ml of 0,5% ropivacaine was injected, as shown. Results Adequate surgical anesthesia was achieved 30 min later. Extra local anesthesia was needed for the incision close to the inguinal ligament, plus remifentanil infusion (0,02–0,04 μg/kg/min) for sedation. The operation lasted 2 hours and the total administation of fentanyl was 2 μg/kg during the procedure. Conclusions FBG nerve block plus local anesthesia can be an alternative for femoral endarterectomy.