Combined high thoracic and lumbar epidural block for a patient with severe peripheral vascular disease undergoing axillo bifemoral bypass surgery

A 63 years old patient with severely impaired pulmonary function presented with bilateral lower limb vascular blockade and was operated for emergency aortobifemoral bypass. The patient was considered to be at very high risk for general anesthesia but doing the case under regional anesthesia was also challenging because of the multiple dermatomal levels needed to be anesthetized and because of the potential of adverse effects with such extensive block. There are only a few reported cases of using combination of central neuraxial blocks. The procedure was successfully performed using combined high thoracic and lumbar epidural blockade with two different local anesthetics to minimizing toxicity and observing no adverse effects related to anesthesia technique.