Summary
Background. Gangrene of the lower limb is one of the numerous diabetes-related complications requiring surgical treatment. Due to co-existing systemic conditions, the procedure of choice in such cases seems to be the regional block rather than general anaesthesia.
Case report. A 64-year-old patient with type 2 diabetes was qualified for amputation of the hallux and lateral malleolus of the left foot due to diabetic gangrene. For many years, the patient has been treated for hypertension, atrial fibrillation, cardiomyopathy, coronary disease and obesity. She had an implantable cardioverter defibrillator (ICD) implanted because of arrhythmias. The patient underwent distal sciatic nerve blockage from lateral approach located 12 cm proximally to the patella, between the biceps femoris and vastus lateralis; 40 ml of 0.75% ropivacaine were used. Postoperative analgesia with a continuous infusion of ropivacaine and sulfentanyl 4 ml h^-1 was continued for 4 days. The course of anaesthesia, surgery and postoperative period was uneventful and the patient was discharged home after 14 days of hospitalization.
Discussion. Distal sciatic nerve block is an effective and safe method of anaesthesia in patients with diabetic foot. The method may be regarded as an alternative to epidural or subarachnoid blockage in patients with obesity, lumbar degenerative changes or those receiving anticoagulants.