Regional anesthesia is central to multimodal analgesia for lower-extremity amputation. Altered anatomy following prior vascular interventions may preclude standard femoral, adductor canal, or popliteal sciatic approaches. Liposomal bupivacaine (LB) received FDA approval for adductor canal and popliteal sciatic blocks in 2023, yet its utility in other lower extremity blocks remains undefined. We present a medically challenging case where a fascia iliaca (FI) catheter and transgluteal sciatic block with LB provided surgical anesthesia and prolonged analgesia.

Discussion Points:

1. Liposomal bupivacaine provides prolonged analgesia with lower systemic plasma concentrations compared to continuous perineural infusion. 

2. Transgluteal sciatic LB appears safe despite proximal injection outside the FDA-studied popliteal space

3.  Combined proximal regional strategies may provide a viable alternative when distal anatomy precludes standard BKA blocks.