Gedikoglu Murat, Eker Hatice E
Department of Radiology, Baskent University School of Medicine, Adana, Turkey.
Department of Anaesthesiology, Baskent University School of Medicine, Adana, Turkey.
Pol J Radiol. 2019 Dec 13;84:e537-e541. doi: 10.5114/pjr.2019.91271. eCollection 2019.
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.
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.
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.
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.
严重缺血肢体的疼痛管理存在挑战。尽管基于阿片类药物的治疗一直是缓解疼痛的基石，但由于这些药物在这类脆弱患者中存在副作用，其使用应受到限制。我们评估了坐骨神经阻滞作为缓解严重静息痛的替代方法在下肢严重缺血血管内治疗中的实用性和有效性。
我们回顾性研究了10例在下肢严重缺血血管内治疗期间接受超声引导下腘窝坐骨神经阻滞以缓解严重静息痛的患者。通过主观标准评估疼痛缓解程度，从无疼痛缓解（=1）到完全疼痛缓解（=4）。记录血管内治疗的细节、进行阻滞的时间、局部麻醉药的用量、阻滞持续时间、补充镇痛的需求、患者和操作者的满意度以及并发症。
所有阻滞技术上均成功，所有患者在5分钟内疼痛完全缓解。2例患者的疼痛缓解程度为3级，8例患者为4级。所有患者对阻滞麻醉满意，在此期间无患者需要额外镇痛。所有病例中操作者满意度都很高。没有患者发生阻滞继发的并发症。
超声引导下腘窝坐骨神经阻滞可有效控制疼痛，在伴有严重静息痛的下肢严重缺血血管内治疗期间，能使患者和操作者满意度极高。
