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

Türeli, Derya; Deniz, Sinan; Unlukaplan, Aytekin; Oğuzkurt, Levent

doi:10.1007/s00270-017-1802-2

Cited by 14 publications

(8 citation statements)

References 16 publications

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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“…Existing studies suggested that intravenous morphine 10 and ultrasound-guided peripheral nerve block provided satisfactory analgesia effect on patients with CLI. [11][12][13][14] However, the analgesia effect of intravenous morphine and ultrasound-guided regional block has not been compared before. Therefore, in this study, we plan to compare the perioperative analgesia effect of patient-controlled regional analgesia (PCRA) and patient-controlled intravenous analgesia (PCIA) for patients diagnosed with CLI.…”

Section: Open Accessmentioning

confidence: 99%

Perioperative patient-controlled regional analgesia versus patient-controlled intravenous analgesia for patients with critical limb ischaemia: a study protocol for a randomised controlled trial

Chen

Liu

et al. 2020

BMJ Open

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IntroductionBoth regional analgesia and intravenous analgesia are frequently used perioperatively for patients with critical limb ischaemia (CLI). Nevertheless, the comparison of perioperative effect of regional and intravenous analgesia has not yet been thoroughly illustrated. This study will comprehensively compare patient-controlled regional analgesia (PCRA) and patient-controlled intravenous analgesia (PCIA) as two different perioperative analgesia approaches for patients with CLI. It investigates their effects on analgesia, reperfusion and the quality of recovery perioperatively, also aims to provide clinical evidence to those non-surgical patients with non-reconstructable arteries.Methods and analysisThis trial is a randomised, single-centre, open-label, parallel trial with target sample size of 52 in total. Eligible participants will be randomly allocated to the PCRA group (group R) or the PCIA group (group I) after admission. Participants in group R will receive ultrasound-guided subgluteal sciatic catheterisation, followed by continuous PCRA infusion (0.2% ropivacaine 15 mL as loading dose, 8 mL/hour as background with a patient-controlled bolus of 6 mL). Participants in group I will receive PCIA (morphine is given in boluses of 1 mg as needed, background infusion at 1 mg/hour). Data will be collected at baseline (T0), 2 hours before revascularisation treatment (T1) and 2 hours before discharge (T2). The primary outcomes include the Numerical Rating Scale pain score at T1 and T2. The secondary outcomes include the perioperative transcutaneous oxygen pressure, the Tissue Haemoglobin Index, Hospital Anxiety and Depression Scale at T1 and T2; the Patient Global Impression of Change and patient satisfaction at T1 and T2; the perioperative cumulative morphine consumption, the length of postoperative hospital stay and adverse events.Ethics and disseminationThis study received authorisation from the Institutional Review Board of Peking Union Medical College Hospital on 21 March 2017 (approval no. ZS-1289X). Study findings will be disseminated through presentations at scientific conferences or publications in peer-reviewed journals.Trial registration numberChinese Clinical Trial Registry (ChiCTR2000029298).Protocol versionV.4CP.B2 (15 June 2020).

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Endovascular revascularization of critical limb ischemia: the role of ultrasound-guided popliteal sciatic nerve block for the procedural pain management

et al. 2023

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

Abstract: Level 4, case series.

Cited by 14 publications

References 16 publications

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

Perioperative patient-controlled regional analgesia versus patient-controlled intravenous analgesia for patients with critical limb ischaemia: a study protocol for a randomised controlled trial

Endovascular revascularization of critical limb ischemia: the role of ultrasound-guided popliteal sciatic nerve block for the procedural pain management

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