A 45-year-old male without known drug allergies.
His personal history included: former smoker 30 packs/year), diabetes mellitus 2, hypercholesterolemia, an antiphospholipid antibody history with history of two deep venous thrombosis.
In October 2004, a left iliac stent plus a left-right femoral-femoral bypass had been placed.
In February 2005, dilation was performed with cryotherapy of the left iliac, which is not effective so that it is performed by femoral-popliteal bypass in the first portion of the left lower limb.
In February 2006, he was admitted again to the vascular surgery service due to a short claudication clinic.
In a first intervention a bilateral ileo-femoral bypass was performed with placement of an epidural catheter for postoperative analgesia.
The postoperative period was unsatisfactory, so three days later a new intervention was performed: common femoral by-pass with left internal saphenous vein.
After 24 hours of evolution, the epidural catheter is lost and intravenous analgesia is currently used.
Four days later the evolution is inadequate, with an ischaemic foot, cold fingers, signs of pre-necrosis, together with severe pain requiring treatment with transdermal fentanyl, rescues with oral steroid hydrochloride for 5 mg daily.
The consultation of the Anesthesiology Service (degree of pain) rejects the placement of a new epidural catheter because the patient is on oral anticoagulant therapy.
It was decided to place a sciatic catheter (Stimulong-plus Plexos Cateter set 19 G-100 mm Pajunk®), which is performed in the operating room, with neurostimulation Lateba proximally.
Infusion with bupivacaine 0.37 % to 3-5 ml/hour is then initiated.
Two days later the foot looks much better.
Six days after placement of the catheter, the patient began to suffer from constipation, losing the sciatic catheter three days later, and then underwent intravenous analgesia.
He was discharged 2 days later with a satisfactory evolution.
