A Case Report: Combined Sciatic Nerve and Lumbar Plexus Nerve Block in A Patient with Acute Decompensated Heart Failure Undergoing Lower Extremity Surgical Debridement

Irma Lusiana Tantri, Natalia Frederika Darmawan Adji Saroso, Marielle Ancilla Domini, Veronica Wiwing


Background: Peripheral nerve block for lower extremity surgeries requires a minimum of two block injections. Although the combination of the lumbar plexus block and the sciatica block is a procedure that requires large doses of local anesthetic, which may induce cardiotoxicity, a recent study suggests that change in the hemodynamic system is not clinically significant.

Case Description: We report a case of a 53-year-old male presenting with a worsened shortness of breath two days before hospital admission. He also experienced a sudden high fever and pain on his right thigh. The patient had a history of Heart Failure (EF 28%) and Congestive liver disease and was diagnosed with right femur cellulitis with right phlegmon. Surgical debridement was planned to treat sepsis. Right lumbar plexus block and right sciatica block were performed as surgical anesthesia. The surgery duration was one hour, and the patient was transferred to the PACU. The patient was treated in ICU before being admitted to the general ward and was discharged on day three post-surgery.

Conclusion: The combination of Sciatic nerve and lumbar plexus nerve block is an effective anesthesia and analgesia technique for lower limb surgery in individuals with a severe heart condition. 


Lumbar plexus block; Sciatic nerve block; Heart failure; Lower extremity surgery; CSLPB

DOI: http://dx.doi.org/10.19166/med.v11i1.7366

Full Text:



1. Abrahams MS, Aziz MF, Fu RF, Horn JL. Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: A systematic review and meta-analysis of randomized controlled trials. Br J Anaesth. 2009;102(3):408-17. https://doi.org/10.1093/bja/aen384

2. Leeuw MA, Slagt C, Hoeksema M, Zuurmond WW, Perez RS. Hemodynamic changes during a combined psoas compartment-sciatic nerve block for elective orthopedic surgery. Anesth Analg. 2011;112(3):719-24. https://doi.org/10.1213/ane.0b013e318206bc30

3. Prerana Jogdand PMS. Comparative study of psoas compartment block and sciatic nerve block with that of a spinal block anesthesia for lower extremity surgeries. Indian Journal of Clinical Anaesthesia. 2018;5(1):141-6. https://doi.org/10.18231/2394-4994.2018.0024

4. Demirel I, Ozer AB, Duzgol O, Bayar MK, Karakurt L, Erhan OL. Comparison of unilateral spinal anesthesia and l(1) paravertebral block combined with psoas compartment and sciatic nerve block in patients to undergo partial hip prosthesis. Eur Rev Med Pharmacol Sci. 2014;18(7):1067-72.

5. Adali S, Erkalp K, Erden V, Comlekci M, Bulbul M, Aldemir T. Spinal anesthesia and combined sciatic nerve/lumbar plexus block techniques in lower extremity orthopedic surgery. Acta Orthop Traumatol Turc. 2011;45(2):225-32. https://doi.org/10.3944/aott.2011.2125

6. Nielsen MV, Bendtsen TF, Borglum J. Superiority of ultrasound-guided shamrock lumbar plexus block. Minerva Anestesiol. 2018;84(1):115-21. https://doi.org/10.23736/s0375-9393.17.11783-9

7. Sauter AR, Ullensvang K, Niemi G, Lorentzen HT, Bendtsen TF, Borglum J, et al. The shamrock lumbar plexus block: A dose-finding study. Eur J Anaesthesiol. 2015;32(11):764-70. https://doi.org/10.1097/eja.0000000000000265

8. Pangthipampai P, Tangwiwat S, Pakpirom J, Songthamwat B, Karmakar MK. Ultrasound visualization of the anatomy relevant for lumbar plexus block: Comparison of the paramedian transverse and shamrock scan technique. Reg Anesth Pain Med. 2019;rapm-2018-100011. https://doi.org/10.1136/rapm-2018-100011

9. Karmakar MK, Kwok WH, Ho AM, Tsang K, Chui PT, Gin T. Ultrasound-guided sciatic nerve block: Description of a new approach at the subgluteal space. Br J Anaesth. 2007;98(3):390-5. https://doi.org/10.1093/bja/ael364


  • There are currently no refbacks.

Copyright (c) 2023 Irma Lusiana Tantri, Natalia Frederika Darmawan Adji Saroso, Marielle Ancilla Domini, Veronica Wiwing

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.


Creative Commons License

MEDICINUS is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License. Copyright © Fakultas Kedokteran | Universitas Pelita Harapan | Lippo Karawaci, Tangerang, Indonesia, 15811 . All rights reserved. p-ISSN 1978-3094 | e-ISSN 2622-6995