Successful Use of Peripheral Nerve Blocks for Emergent Trauma Surgery in a Patient With Perioperative Myocardial Infarction: A Case Report.

Patients with concurrent trauma-related surgical emergencies and ST-segment elevation myocardial infarction (MI) present a unique anesthetic challenge, as damage control surgery and rapid resuscitation must take priority over timely coronary revascularization. During these surgeries, the physiologic insult from general anesthesia can be detrimental to a failing heart, so regional anesthesia techniques and their implications in trauma should be considered. We present a 62-year-old male motorcyclist with hypertension, diabetes, and coronary artery disease and a history of percutaneous coronary intervention who was hit by a car and presented with traumatic partial amputation of the left leg. The patient was brought to the operating room for a left below-knee amputation, and ST-segment elevation in lead II was noted. A 12-lead electrocardiogram showed elevations in II, III, and aVF. We discussed the need for surgery and proceeded with regional anesthesia via left femoral and lateral popliteal sciatic nerve blocks. After surgery, angiography in the cardiac catheterization suite revealed total thrombotic occlusion of the right coronary artery. Cardiology performed thrombectomy, angioplasty, and stent placement. Throughout the hospital course, the patient required multiple incision and drainage procedures, an above-knee amputation, and a second revascularization, all under regional anesthesia. He was eventually discharged to acute rehabilitation. This case underscores the value of damage control surgery and rapid resuscitation, which are paramount for trauma patients with perioperative MIs prior to coronary revascularization. The ability to proceed with regional techniques to avoid the physiologic insult of general anesthesia is invaluable. There are unique considerations for regional anesthesia in trauma patients, such as consent and communication, positioning limitations, coagulopathies, unknown history, and risk of compartment syndrome and infection.