Department of Surgical Sciences, Radiology Unit, University of Torino, Via Genova 3, 10126, Turin, Italy.
Department of Surgical Sciences, Division of Vascular Surgery, University of Torino, Turin, Italy.
Eur Radiol. 2024 Jan;34(1):287-293. doi: 10.1007/s00330-023-09988-0. Epub 2023 Jul 29.
To evaluate the impact of the ultrasound-guided popliteal sciatic nerve block (PSNB) for pain management during endovascular treatment of chronic limb-threatening ischemia (CLTI).
From November 2020 to January 2022, 111 CLTI patients that underwent endovascular procedures were prospectively enrolled in this prospective single-arm interventional study. Ultrasound-guided PSNB was used for procedural pain control. Pain intensity was evaluated throughout the procedure (baseline, 10 min after the block, pain peak, and at the end of the procedure) with the visual analog scale (VAS).
Forty-six patients underwent above-the-knee revascularization (ATK), 20/111 below-the-knee (BTK) revascularization, 20/111 to both ATK and BTK revascularization. In 25 cases, no endovascular option was feasible at diagnostic angiography. The PSNB was effective in 96% of patients, with no need for further pain management with a statistically significant reduction (p < 0.0001) in the mean value of the VAS from 7.86 ± 1.81 (pre-procedural) to 2.04 ± 2.20 after 10 min from the block and up to 0.74 ± 1.43 at the end of the procedure (mean time 43 min). Only 1 complication related to the popliteal sciatic nerve block was registered (a temporary foot drop, completely resolved within 48 h). The time necessary to perform the block ranged between 4 and 10 min.
Ultrasound-guided PSNB is a feasible and effective method to manage patients with rest pain and increase comfort and compliance during endovascular procedures.
An ultrasound-guided popliteal sciatic nerve block is a safe, feasible, and effective technique to manage pain during endovascular treatment of chronic limb-threatening ischemia, especially in frail patients with multiple comorbidities who are poor candidates for deep sedoanalgesia or general anesthesia.
Endovascular treatment of CTLI may require long revascularization sessions in patients with high levels of pain at rest, which could be exacerbated during the revascularization procedure. The PSNB is routinely used for anesthesia and analgesia during foot and ankle surgery, but the experience with lower limb revascularization procedures is very limited and not included in any international guideline. Ultrasound-guided PSNB is a feasible and effective regional anesthesia technique to relieve procedural and resting pain. Because of its safety and availability, every interventional radiologist should know how to perform this type of loco-regional anesthesia.
评估超声引导下腘窝坐骨神经阻滞（PSNB）在慢性肢体威胁性缺血（CLTI）的血管内治疗中用于疼痛管理的效果。
从 2020 年 11 月至 2022 年 1 月，前瞻性纳入了 111 例接受血管内治疗的 CLTI 患者，进行这项前瞻性单臂介入研究。超声引导下 PSNB 用于手术过程中的疼痛控制。使用视觉模拟评分（VAS）在整个过程中评估疼痛强度（基线、阻滞 10 分钟后、疼痛峰值和手术结束时）。
46 例患者接受了膝上再血管化（ATK），111 例患者中 20 例接受了膝下再血管化（BTK），111 例患者中 20 例同时接受了 ATK 和 BTK 再血管化。在 25 例患者中，诊断性血管造影术无可行的血管内治疗方案。PSNB 在 96%的患者中有效，不需要进一步的疼痛管理，VAS 的平均值从 7.86±1.81（术前）显著降低到阻滞 10 分钟后 2.04±2.20（p<0.0001），直至手术结束时 0.74±1.43（平均时间 43 分钟）。仅登记了 1 例与腘窝坐骨神经阻滞相关的并发症（暂时性足下垂，48 小时内完全缓解）。进行阻滞的时间范围为 4 至 10 分钟。
超声引导下 PSNB 是一种可行且有效的方法，可用于管理静息痛患者，并在血管内治疗期间增加舒适度和依从性。
超声引导下腘窝坐骨神经阻滞是一种安全、可行且有效的技术，可用于治疗慢性肢体威胁性缺血的血管内治疗期间的疼痛，特别是在因多种合并症而身体虚弱、不适合深度镇静镇痛或全身麻醉的患者中。
CTLI 的血管内治疗可能需要对静息时疼痛程度较高的患者进行长时间的再血管化治疗，而在再血管化过程中，疼痛可能会加剧。PSNB 通常用于足部和踝关节手术的麻醉和镇痛，但下肢再血管化手术的经验非常有限，且不在任何国际指南中。超声引导下 PSNB 是一种可行且有效的区域麻醉技术，可缓解手术和静息时的疼痛。由于其安全性和可用性，每个介入放射科医生都应该知道如何进行这种类型的局部区域麻醉。
