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

Abstract

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.

Popliteal sciatic nerve block for high-risk patients undergoing lower limb angioplasty: A prospective double-blinded randomized controlled trial

“…[12] There is evidence that, in most cases, ischemic pain can be effectively treated by peripheral nerve block or by lumbar sympathetic nerve block. [9,11,13,14] Several case reports suggest that regional anesthesia may not always conceal the pain manifested in compartment syndrome. [15][16][17][18] Tissue acidosis with increased release of hydrogen ions may explain this pain.…”

“…[ 8 ] Recent cohort studies suggest that ultrasound-guided PSNB is an effective technique to relieve procedural and resting ischemic pain during endovascular revascularization. [ 9 , 10 ] However, there is no randomized controlled trial has been done to support this suggestion. Therefore, this research has been conducted.…”

Continuous peripheral nerve block for in-patients with lower limb ischemic pain

“…The present study corroborates these data and adds lower limb ischemic pain as an indication of CSNB, without the systemic effects that commonly occur with systemic analgesia. As most PAOD patients suffer with lower limb ischemia and foot ischemic pain, the sciatic nerve block in the popliteal fossa provides good analgesia, with minor adverse effects (12).…”

Lateral Approach of Popliteal Block Versus Unilateral Spinal Anesthesia for Below Knee Surgeries: A Comparative Study

“…There are various techniques when administering anesthetic to the therapeutic plexus of nerves of the popliteal fossa. Single and double injection, continuous infusion and bolus dosing through a perineural catheter, and the use of electrical stimulation with or without ultrasound guidance have all been described [9].…”