Successful Sciatic Nerve Block for a Patient with Severe Coronary Artery Disease Who Underwent Arterial Thrombectomy

Few studies have examined the frequency or severity of hemorrhagic complications following plexus or peripheral block in patients on anticoagulant therapy. We report successful anesthetic management by sciatic nerve block (SNB) of a patient with severe coronary artery disease who underwent lower-limb arterial thrombectomy and revascularization. A 72-year-old female with arteriosclerosis obliterans was diagnosed with acute arterial thrombosis and scheduled for emergency surgery. She had heart failure caused by three-vessel coronary artery disease and was taking anticoagulant therapy of warfarin and cilostazol. We performed SNB (popliteal approach) using a single injection of 20 ml 0.5% ropivacaine guided by ultrasound echography. There were no hemodynamic or respiratory disturbances during the operation. She had no local hematoma or neural disturbances during the clinical course, although heparin infusion was initiated perioperatively. Anesthetic management using SNB was successful. Ultrasound-guided SNB could be a useful technique in patients receiving anticoagulant therapy.