Amputation – Below the Knee (BKA)

Anesthesia Implications

Position: Supine
Time: 1-2 hours (average)
Blood Loss: Moderate (50 – 200 ml)
Post-op Pain: High (7-10)
Maintenance Paralytic: No
Blocks: Adductor Canal, Femoral, Popliteal, Saphenous, Sciatic

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.

High post-operative pain (general considerations): Plan ahead to treat pain in the postoperative period. If not contraindicated, consider hydromorphone or other long-acting analgesics along with adjuncts such as Ofirmev and/or toradol. Where possible, give during the operative period to limit pain in the postoperative period. Where applicable, consider peripheral nerve blocks and/or epidural interventions.