<![CDATA[Background: Septic patients requiring urgent below-knee amputation (BKA) represent a particularly high-risk anesthetic population due to vasoplegia, myocardial dysfunction, and multiorgan impairment. In this setting, general anesthesia may exacerbate cardiovascular depression, while neuraxial techniques risk profound sympathectomy-induced hypotension.Case: A 53-year-old man with sepsis secondary to a diabetic foot ulcer, complicated by chronic kidney disease and severe anemia, required urgent BKA. An ultrasound-guided adductor canal block with 2% lidocaine and a popliteal sciatic nerve block with 0.5% levobupivacaine were performed. Adequate surgical anesthesia was achieved without airway instrumentation or intraoperative opioid administration. The 90-minute procedure was completed with stable hemodynamics and no significant fluctuations. Postoperative pain scores remained below 3/10 during the first 12 hours under an opioid-free multimodal regimen. The patient’s septic condition improved, and he was discharged on postoperative day four without major complications.Discussion: In septic patients, avoiding systemic vasodilation and myocardial depression is critical. PNBs provide targeted neural blockade while preserving sympathetic tone, potentially reducing intraoperative hypotension. Ultrasound guidance enhances precision and safety, making PNBs a viable primary anesthetic option in selected high-risk patientsConclusion: Ultrasound-guided peripheral nerve blocks can provide effective surgical anesthesia with hemodynamic stability in septic patients undergoing urgent BKA, supporting their role as a strategic alternative in vulnerable populations]]>
