bandage-green

Amputation - Below the Knee (BKA)

Anesthesia Implications
Position : Supine
Time : 1-2 hours (average)
Blood Loss : Moderate (50 - 200 ml)
Maintenance Paralytic : No
Blocks : Adductor Canal, Femoral, Popliteal, Saphenous, Sciatic

Anesthetic Approaches

1MAC, Spinal
2GLMA
3GETT
The Anesthesia:

Phantom limb pain - Ketamine is a very effective treatment for phantom limb pain, which is experienced in approximately 80% of amputees. In the cited article, an infusion of 300 mcg/kg + 2mg of versed in 60ml of crystalloid, given over 3 hours, and every other day for 12 days, substantially reduced/eliminated these problems. Approach - Many of these patients are very sick. It's been suggested that popliteal + saphenous blocks or spinals (if not contraindicated) with light sedation is a good approach for these patients.


Reference

Shanthanna. Early and effective use of ketamine for treatment of phantom limb pain. 2010.