Ultrasound Guided Femoro-popliteal Block for Below Knee Amputation in a Patient with Gas Gangrene with Coagulopathy


Vol 9 | Issue 1 | January-April 2023 | Page: 01-03 | Sheetal Chiplonkar, Pratibha Toal, Jalpa Kate, Nidhi Chitravanshi

DOI: https://doi.org/10.13107/jaccr.2023.v09i01.210

Author: Sheetal Chiplonkar [1], Pratibha Toal [1], Jalpa Kate [1], Nidhi Chitravanshi [1]

[1] Department of Anaesthesia, BARC Hospital, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Sheetal Chiplonkar,
Senior Consultant, Department of Anaesthesia, BARC Hospital, Mumbai, Maharashtra, India.
E-mail: drsheetalchiplonkar@gmail.com


Introduction: Gas gangrene is a necrotic infection of soft tissue associated with high mortality, often necessitating amputation in order to control the infection.
Method: We present a case of emergency below knee amputation in a patient with lower limb gas gangrene. He was a known diabetic, hypertensive, alcoholic and on warfarin for central venous thrombosis and presented in septic shock. Crepitus and gram staining of the wound confirmed the diagnosis of gas gangrene. Immediate warfarin reversal was facilitated with Fresh frozen plasma and Vitamin K prior surgery. Ultrasound was used for Central Venous Catheter placement and administering femoro-popliteal nerve block.
Results: Below knee amputation was successfully performed uneventfully and patient was later discharged home.
Conclusion: Timely intervention and combined efforts of surgical, microbiology and anaesthesia team resulted in lifesaving procedure for the patient.
Ultrasonography guidance was of immense help in performing regional procedures especially during coagulopathy where risk of bleeding due to blind procedures would have been high.
Keywords: Gas gangrene, Femoropopliteal nerve block, Ultrasonography


1. Rashidi A, Tahhan HR. fresh frozen plasma dosing for warfarin reversal: A practical formula, Mayo Clin Proc. 2013; 88(3): 244-50
2. Leiblein M,Wagner N, Adam EH, Frank J, Marzi I, Nau C. Clostridial Gas Gangrene – A Rare but Deadly Infection: Case seriesand comparison to other necrotizing soft tissue infections. Orthop Surg.2020;12(6):1733-1747.
3. Schwebach AA, Waybright RA, Johnson TJ. Fixed dose four factor prothrombin complex concentrate for vit. K antagonist reversal: Does one dose fit all? Pharmacotherapy.2019;39(5):599-608
4. Best CA, Best AA, Best TJ, Hamilton DA. Buffered lidocaine and bupivacaine mixture – the ideal local anesthetic solution? Plast Surg (Oakv). 2015 Summer;23(2):87-90.
5. Nasr-Esfahani M, Kolahdouzan M, Mousavi SA. Inserting central venous catherter in emergencyconditions in coagulopathic patients in comparison to non coagulopathic patients. J Res Med Sci.2016;21:120

How to Cite this Article: Chiplonkar S, Toal P, Kate J, Chitravanshi N | Ultrasound Guided Femoropopliteal Block for Below Knee Amputation in a Patient with Gas Gangrene with Coagulopathy | Journal of Anaesthesia and Critical Care Case Reports | January- April 2023; 9(1): 01-03 | https://doi.org/10.13107/jaccr.2023.v09i01.210

(Abstract Text HTML)     (Download PDF)

Tags: , ,