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

Hermann Dos Santos Fernandes,Jorge Luiz Saraiva Ximenes,Paloma Kiyomi Taguchi,Eloisa Bonetti Espada,Áquila Lopes Gouvêa,Joaquim Edson Vieira,Hazem Adel Ashmawi

doi:10.6061/clinics/2021/e2805

Hermann Dos Santos Fernandes, Jorge Luiz Saraiva Ximenes + Show 5 more

Open Access

https://doi.org/10.6061/clinics/2021/e2805

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Journal: Clinics	Publication Date: Jan 1, 2021
Citations: 3	License type: cc-by

Abstract

OBJECTIVES:Demonstrate that continuous peripheral nerve block (CPNB) may be an alternative with adequate analgesia and a lower incidence of side effects for ischemic pain due peripheral obstructive arterial disease (POAD).METHODS:Retrospective cohort study with 21 patients with POAD, Fontaine IV graded, with foot pain. Patients were submitted to continuous sciatic nerve block (CSNB), through a perineural catheter. Primary outcomes were pain intensity (by numerical rating scale) and opioid consumption (in oral morphine equivalents).RESULTS:During CSNB, pain scores markedly decreased in comparison to the pre-block period.CONCLUSIONS:CPNB may be a good option for ischemic pain treatment in in-patients, as it provides effective pain control with fewer adverse effects.

Highlights

Peripheral arterial obstructive disease (PAOD) is frequent among the elderly [1]
Exclusion criteria were: patients who did not accepted Continuous peripheral nerve block (CPNB) as a pain treatment option, non-cooperative patients, those with coagulation disorders, systemic or block site infection, allergies to local anesthetic and difficulty understanding the use of the patient-controlled analgesia (PCA) device, and those who refused to be submitted to peripheral nerve block
This study demonstrated that the use of continuous sciatic nerve block (CSNB) in patients with lower limb PAOD is a viable and effective alternative for ischemic pain treatment, with a milder adverse effects profile

Summary

Introduction

Peripheral arterial obstructive disease (PAOD) is frequent among the elderly [1]. Ischemic pain is the main symptom and affects the quality of life [2]. Reversing the arterial obstruction is the main treatment objective, but until pain management is essential [3]. Continuous peripheral nerve block (CPNB) may offer an advantage. As lower limb ischemic pain predominates in the foot [6], a viable option would be the approach of the sciatic nerve. There are proven benefits for continuous sciatic nerve block (CSNB) after painful orthopedic procedures [7]. There are only few retrospective studies and case reports of this technique for the treatment of lower limb ischemic pain [8,9,10]

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