A New Approach: Regional Nerve Blockade for Angioplasty of the Lower Limb

Marcus, Adrian; Lotzof, Kevin; Kamath, B.S.K.; Shanthakumar, R.E.; Munir, Nazia; Loh, Ai Poh; Bird, Richard; Howard, Adam

doi:10.1007/s00270-004-0084-7

Cited by 14 publications

(13 citation statements)

References 5 publications

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“…No RCTs or other Level I or II evidence-based trials were identified. Ten articles (three observational studies [4][5][6] and seven case reports/series [7][8][9][10][11][12][13] met inclusion criteria for review, which are displayed in Table 1. While no prospective observational studies regarding peripheral nerve catheters in this population have been reported, all three included retrospective studies [4][5][6] and five of seven case reports/series [7-9, 12, 13] demonstrated improved analgesia for ischemic pain after implementation of regional anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Partnering with Palliative Care: A Case Report of Severe Pain in Critical Limb Ischemia Treated Successfully with a Continuous Popliteal Nerve Catheter

D’Souza

Shen

Ojukwu

et al. 2020

Case Reports in Anesthesiology

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Background. Critical limb ischemia (CLI) is limb pain occurring at rest or impending limb loss as a result of lack of blood flow to the affected extremity. CLI pain is challenging to control despite multimodal pharmacologic analgesia and surgical intervention. We described the successful use of a continuous local anesthetic infusion via a popliteal nerve catheter to control severe refractory ischemic lower limb pain in a patient who failed surgical intervention and performed a brief narrative literature review on regional anesthesia for ischemic pain. Case Presentation. A 74-year-old female with acute myelogenous leukemia presented with CLI after experiencing left popliteal artery occlusion. Palliative medicine service was consulted for pain management in the setting of escalating narcotic dose requirements. She experienced a complicated hospital course with several failed attempts at surgical revascularization due to arterial rethrombosis. In accordance with the patient’s goals of care, a continuous popliteal nerve catheter was placed, despite the high risk nature of an intervention in an immunocompromised patient with thrombocytopenia (platelet count of 30,000 platelets/microliter) and ongoing therapeutic anticoagulation. The patient experienced immediate relief while transitioning to comfort care. Conclusion. This is the first report of successful analgesia for CLI via a continuous popliteal catheter in a patient with rethrombosis and failed surgical revascularization. Based on our collaborative experience, we recommend the development of partnerships between the acute pain service and palliative care service to facilitate the early evaluation and decision to utilize regional anesthesia for treatment of CLI.

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Section: Discussionmentioning

confidence: 99%

Partnering with Palliative Care: A Case Report of Severe Pain in Critical Limb Ischemia Treated Successfully with a Continuous Popliteal Nerve Catheter

D’Souza

Shen

Ojukwu

et al. 2020

Case Reports in Anesthesiology

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“…Ideally, relief of pain is achieved by reperfusion of the limb in patients with CLI [1,2]. Pain control may be urgently needed in these patients until revascularisation can be provided [1][2][3]9,15,16]. In severe cases, the pain occurs only after a short period of supine rest, and it may become impossible for the patients to lie on their back for a long time.…”

Section: Discussionmentioning

confidence: 99%

“…Many patients with CLI exhibit symptoms of anxiety and poor compliance with prolonged revascularisation procedures. Moreover, they may have abnormal behaviour involving hyperactive or hypoactive psychomotor activity, disturbances of attention, or disorientation [1][2][3]8,15,16]. Although they may need effective pain control with higher levels of opioid medications during these interventions, they have poor tolerance to strong opioids.…”

Section: Discussionmentioning

confidence: 99%

“…The achievement of a pain-free state without narcotic medications allows the patients to continue their cooperation with immobility in their leg during uncomfortable endovascular interventions. Therefore, nerve blocks may also provide a contribution to operator comfort during these complex and prolonged endovascular treatments [15,16].…”

Section: Discussionmentioning

confidence: 99%

“…It may be used to relieve acute pain emergencies, including distal lower limb fractures, and for postoperative pain control while waiting for alternative medications to become effective. Recent clinical studies have emphasised the use of SNB as an alternative method to improve pain management during endovascular treatment of CLI with severe rest pain [15,16]. They reported that SNB can be a useful tool to provide adequate analgesia and reduce the amount of opioids or anaesthesia required.…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound-guided popliteal sciatic nerve block: an effective alternative technique to control ischaemic severe rest pain during endovascular treatment of critical limb ischaemia

Gedikoglu¹,

Eker²

2019

Pol J Radiol

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Purpose: There are challenges with pain management related to a severely ischaemic limb. Although opioid-based treatment has been the cornerstone of pain relief, the use of these drugs should be limited because of their side effects in such vulnerable patients. We evaluated the utility and efficiency of sciatic nerve block as an alternative method to relieve severe rest pain during endovascular treatment of critical limb ischaemia. Material and methods:We retrospectively investigated 10 patients who received ultrasound-guided popliteal sciatic nerve block for the relief of severe rest pain during endovascular treatment of critical limb ischaemia. The degree of pain relief was evaluated by using subjective criteria, from no relief of pain (= 1) to complete relief of pain (= 4). Details of endovascular treatment, time to perform the block, amount of local anaesthetics, duration of the block, need for supplemental analgesia, patient and operator satisfaction, and complications were recorded.Results: All blocks were technically successful, and all of the patients had complete resolution of the pain within five minutes. The degree of pain relief was 3 in two patients and 4 in eight patients. All patients were satisfied with the block anaesthesia, and no patient required additional analgesia during this period. Operator satisfaction was very good in all cases. Complications secondary to block did not occur in any patient. Conclusions:Ultrasound-guided popliteal sciatic nerve block provides effective pain control, which results in excellent patient and operator satisfaction during endovascular treatment of critical limb ischaemia with severe rest pain.

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Ultrasound-Guided Popliteal Sciatic Block Provides Adequate Analgesia During Urgent Endovascular Treatment of Critical Limb Ischemia with Resting Pain

Türeli

Deniz

Unlukaplan

et al. 2017

Cardiovasc Intervent Radiol

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A New Approach: Regional Nerve Blockade for Angioplasty of the Lower Limb

Cited by 14 publications

References 5 publications

Partnering with Palliative Care: A Case Report of Severe Pain in Critical Limb Ischemia Treated Successfully with a Continuous Popliteal Nerve Catheter

Partnering with Palliative Care: A Case Report of Severe Pain in Critical Limb Ischemia Treated Successfully with a Continuous Popliteal Nerve Catheter

Ultrasound-guided popliteal sciatic nerve block: an effective alternative technique to control ischaemic severe rest pain during endovascular treatment of critical limb ischaemia

Ultrasound-Guided Popliteal Sciatic Block Provides Adequate Analgesia During Urgent Endovascular Treatment of Critical Limb Ischemia with Resting Pain

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