Anesthetic Management With Peripheral Nerve Blocks and Sedation for Popliteal Artery Aneurysm Repair in a Patient With Severe Pulmonary Dysfunction: A Case Report

Postoperative pulmonary complications (PPCs), such as pneumonia, atelectasis, and respiratory failure, pose a significant challenge, particularly in patients with compromised respiratory function. Regional anesthesia is well-known for its numerous advantages, including its effectiveness in mitigating PPCs by circumventing the need for general anesthesia and intubation. A 79-year-old man with no significant medical history other than chronic obstructive pulmonary disease presented with left lower limb swelling, gait disturbance, and cold sensation. Computed tomography revealed a 5 cm left popliteal artery aneurysm, which was diagnosed as the cause of the patient's symptoms. He underwent popliteal artery aneurysm repair using peripheral nerve blocks (PNBs) and sedation. Sciatic, femoral, and obturator nerve blocks with 0.25% levobupivacaine provided effective analgesia. Despite intraoperative challenges, such as elevated partial pressure of carbon dioxide (PaCO₂) and prolonged operative time due to vascular reconstruction revisions, the patient remained hemodynamically stable throughout the procedure, and PNBs allowed the preservation of spontaneous respiration. The patient was discharged on postoperative day 15 without pneumonia or respiratory failure. This case underscores the utility of PNBs and sedation in mitigating PPCs like pneumonia.