Dear Editor,
We read with great interest the recent case report by Munasinghe et al. (2025), which described the unusual anaesthetic challenges encountered during a transfemoral amputation in a patient with sciatic nerve liquefactive necrosis. This rare presentation highlights the complex interplay between peripheral nerve pathology and regional anaesthesia techniques, providing valuable insights for anaesthesiologists and surgeons alike [1]. While the case is both intriguing and clinically relevant, several aspects warrant further discussion to enhance its translational value.
First, the report raises critical questions regarding the pathophysiology of sciatic nerve liquefactive necrosis in the context of lower limb pathology. Understanding whether this process is primarily ischemic, infectious, or inflammatory in origin is essential for guiding both perioperative decision-making and long-term limb salvage strategies [2]. However, the authors provide limited histopathological correlation or discussion of possible underlying mechanisms.
Second, the anaesthetic management considerations merit deeper exploration. Although the authors describe challenges with regional anaesthesia, details regarding preoperative nerve imaging, alternative block techniques, or the potential role of adjunctive modalities such as ultrasound-guided nerve mapping are lacking [3]. A discussion on the comparative safety and efficacy of general versus regional anaesthesia in the context of compromised peripheral nerves would have strengthened the case's clinical applicability.
Finally, the report could benefit from a broader review of literature on similar cases or related peripheral nerve pathologies encountered during amputations. This would help contextualize the rarity of the finding, assess potential predisposing conditions such as diabetic neuropathy or chronic limb ischemia, and guide future preventive strategies.
In conclusion, Munasinghe et al. have presented a thought-provoking case that underscores the importance of individualized anaesthetic planning in patients with unexpected peripheral nerve pathology. Future reports should aim to integrate pathophysiological insights, multimodal imaging, and literature comparisons to further elucidate best practices in such challenging surgical scenarios.
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Author contribution
Asadollah Shakeri: Writing and Editing the draft.
Nazli Farnoosh: Writing and Editing the draft.
Aidin Shakeri: Study design, data collection, Writing and Editing the draft.
All authors read and approved the final version of the manuscript.
Guarantor
All the authors of this paper accept full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.
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Conflict of interest statement
The authors have no conflict of interest.
References
- 1.Munasinghe B.M., Jayasuriya N.J. Challenges in regional anaesthesia for transfemoral amputation due to sciatic nerve liquefactive necrosis: A case report. Int. J. Surg. Case Rep. 2025 doi: 10.1016/j.ijscr.2025.111735. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Dietmann A., Von Martial R., Scheidegger O. Spontaneous ischemic neuropathy of the sciatic nerve due to arterial occlusion–a rare cause of acute neuropathy not to be missed, a report of two cases. BMC Neurol. 2022;22(1):410. doi: 10.1186/s12883-022-02944-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Ota J., Sakura S., Hara K., Saito Y. Ultrasound-guided anterior approach to sciatic nerve block: a comparison with the posterior approach. Anesth. Analg. 2009;108(2):660–665. doi: 10.1213/ane.0b013e31818fc252. [DOI] [PubMed] [Google Scholar]