Femoral and Popliteal Nerve Block for Left Foot Amputation: A Case Report in a Patient with Low Ejection Fraction and Recent Clopidogrel Use

Abstract

Introduction: Patients with heart problems are very hard to give anesthesia to especially when they need surgery on their legs. Giving them anesthesia can be really risky because it can make their blood pressure go up and down a lot. This is because their heart is not strong enough and cannot handle the stress of the surgery. There is another way to give anesthesia called anesthesia which is used for leg surgery. However this method can be dangerous for patients who are taking medications, such as clopidogrel because it can cause bleeding in the spine. The American Society of Regional Anesthesia and Pain Medicine says that doctors should be very careful when using this method on patients who are taking these kinds of medications. Some doctors are now using a method, called peripheral nerve blocks, which can be safer for high-risk patients. This method involves numbing the nerves in the leg which can help the patient avoid feeling pain during surgery without affecting their blood pressure (Kopp et al., 2025). Using ultrasound to guide the needle makes this method even safer and more effective (Joubert and Duchalais, 2022). There are not many reports about using peripheral nerve blocks for emergency leg amputations on patients with very bad heart problems who are also taking antiplatelet medications. So we want to share a story, about a patient who had a surgery using this method. The patient had a low ejection fraction and had recently taken clopidogrel but they were still able to have a safe and successful foot amputation using ultrasound-guided femoral and popliteal nerve blocks. Case Presentation: A 57-year-old 90-kg male ASA IV, NYHA Class III with coronary artery disease, hypertension, diabetes, and chronic heart failure (ejection fraction 20%) presented for left foot amputation. He had taken clopidogrel 24 hours prior to surgery, contraindicating neuraxial anesthesia (Kopp et al., 2025). Ultrasound-guided femoral and popliteal nerve blocks were performed using 45 mL of 0.5% bupivacaine (total dose 225 mg, approximately 2.5 mg/kg), which was within the recommended safe dose range for the patient’s body weight. The procedure was completed successfully with stable hemodynamics throughout. Conclusion: Ultrasound-guided femoral and popliteal nerve blocks are a safe, effective option for lower limb amputations in patients with severely reduced cardiac function and recent clopidogrel use (Joubert and Duchalais, 2022). This approach avoids risks of neuraxial blockade while preserving hemodynamic stability.