Continuous sciatic nerve block for below-knee amputation made it possible to reduce postoperative opioid in the multiple trauma patient who had difficulty in pain management under preoperative opioid use: a case report

Abstract

We experienced a case of continuous sciatic nerve block for below-knee amputation in a multiple trauma patient on preoperative opioid therapy. The patient was a 34-year-old male with a history of stimulants dependence. He had traumatic multiple fractures and underwent multiple surgeries. Below-knee amputation was scheduled for tibial osteomyelitis. He had needed high-dose opioid consumption for pain control preoperatively. Because of the risk of opioid abuse and dependence postoperatively, we consulted with the pain clinic specialist. We shared the postoperative pain management with the patient himself, his attending physician and ward staff. After below-knee amputation, pain management was mainly performed with a continuous sciatic nerve block, and opioids were tapered. As for the perioperative management of patients on preoperative opioid therapy, risk classifications of opioid-related adverse events and their management strategies have been published. Our patient was classified as high-risk and was valuable for multidisciplinary collaboration including the pain clinic department, multimodal analgesia including regional anesthesia, and preoperative patient education.