PMID- 37515633
OWN - NLM
STAT- MEDLINE
DCOM- 20240118
LR  - 20240321
IS  - 1432-1084 (Electronic)
IS  - 0938-7994 (Linking)
VI  - 34
IP  - 1
DP  - 2024 Jan
TI  - Endovascular revascularization of critical limb ischemia: the role of 
      ultrasound-guided popliteal sciatic nerve block for the procedural pain 
      management.
PG  - 287-293
LID - 10.1007/s00330-023-09988-0 [doi]
AB  - OBJECTIVES: 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). MATERIAL AND METHODS: 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). RESULTS: 
      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. CONCLUSION: 
      Ultrasound-guided PSNB is a feasible and effective method to manage patients with 
      rest pain and increase comfort and compliance during endovascular procedures. 
      CLINICAL RELEVANCE STATEMENT: 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. KEY POINTS: 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.
CI  - (c) 2023. The Author(s), under exclusive licence to European Society of Radiology.
FAU - Discalzi, Andrea
AU  - Discalzi A
AD  - Department of Surgical Sciences, Radiology Unit, University of Torino, Via Genova 
      3, 10126, Turin, Italy.
FAU - Maglia, Claudio
AU  - Maglia C
AD  - Department of Surgical Sciences, Radiology Unit, University of Torino, Via Genova 
      3, 10126, Turin, Italy.
FAU - Nardelli, Floriana
AU  - Nardelli F
AUID- ORCID: 0000-0002-4047-1873
AD  - Department of Surgical Sciences, Radiology Unit, University of Torino, Via Genova 
      3, 10126, Turin, Italy. floriana.nardelli22@gmail.com.
FAU - Mancini, Andrea
AU  - Mancini A
AD  - Department of Surgical Sciences, Radiology Unit, University of Torino, Via Genova 
      3, 10126, Turin, Italy.
FAU - Rossato, Denis
AU  - Rossato D
AD  - Department of Surgical Sciences, Radiology Unit, University of Torino, Via Genova 
      3, 10126, Turin, Italy.
FAU - Muratore, Pierluigi
AU  - Muratore P
AD  - Department of Surgical Sciences, Radiology Unit, University of Torino, Via Genova 
      3, 10126, Turin, Italy.
FAU - Gibello, Lorenzo
AU  - Gibello L
AD  - Department of Surgical Sciences, Division of Vascular Surgery, University of 
      Torino, Turin, Italy.
FAU - Gobbi, Fabio
AU  - Gobbi F
AD  - Department of Anesthesiology, Ospedale Humanitas Gradenigo, Turin, Italy.
FAU - Calandri, Marco
AU  - Calandri M
AD  - Department of Surgical Sciences, Radiology Unit, University of Torino, Via Genova 
      3, 10126, Turin, Italy.
LA  - eng
PT  - Journal Article
DEP - 20230729
PL  - Germany
TA  - Eur Radiol
JT  - European radiology
JID - 9114774
SB  - IM
EIN - Eur Radiol. 2023 Oct 4;:. PMID: 37794250
MH  - Humans
MH  - Pain Management
MH  - Chronic Limb-Threatening Ischemia
MH  - *Nerve Block/methods
MH  - *Pain, Procedural/complications
MH  - Prospective Studies
MH  - Sciatic Nerve/diagnostic imaging
MH  - Ultrasonography, Interventional/methods
MH  - *Anesthesia, Conduction/adverse effects
MH  - Pain/etiology
OTO - NOTNLM
OT  - Critical limb ischaemia
OT  - Endovascular treatment
OT  - Intraoperative pain management
OT  - Popliteal sciatic nerve block
OT  - Ultrasound-guided regional anesthesia
EDAT- 2023/07/29 21:46
MHDA- 2024/01/18 06:42
CRDT- 2023/07/29 11:04
PHST- 2022/12/28 00:00 [received]
PHST- 2023/06/06 00:00 [accepted]
PHST- 2023/05/07 00:00 [revised]
PHST- 2024/01/18 06:42 [medline]
PHST- 2023/07/29 21:46 [pubmed]
PHST- 2023/07/29 11:04 [entrez]
AID - 10.1007/s00330-023-09988-0 [pii]
AID - 10.1007/s00330-023-09988-0 [doi]
PST - ppublish
SO  - Eur Radiol. 2024 Jan;34(1):287-293. doi: 10.1007/s00330-023-09988-0. Epub 2023 
      Jul 29.