Graded epidural anaesthesia as the sole anaesthetic technique for a life salvaging below knee amputation on a high risk patient: A case report

Abstract

Epidural anaesthesia has been widely accepted and routinely used for many years and widely accepted as an effective method of regional anaesthesia for pain relief. The procedure is commonly performed in combination with spinal or with General anaesthesia. Role of Graded Epidural a sole anaesthetic modality for high risk case is challenging as it requires competency, patience, as well as a supportive team of anaesthesiologist and anaesthesia technicians. Studies reveal that regional anaesthesia has been shown to ameliorate the hyperglycemic as well as catecholamine surge to surgery. We report a case of 56 year old man admitted with diabetic gangrene with features suggestive of impending sepsis taken up on emergency basis for below knee amputation. Pre-existing cardiac condition with long standing diabetes mellitus complicated with retinopathy along with features suggestive of impending sepsis, although made patient unfit for all modes of Anaesthesia, as a lifesaving surgery was planned we decided to give a trial of sole Graded Epidural Anaesthesia, keeping in mind to manage postoperative amputation pain.