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CardioVascular and Interventional Radiology
Published in: CardioVascular and Interventional Radiology 1/2018

01-01-2018 | Clinical Investigation

Ultrasound-Guided Popliteal Sciatic Block Provides Adequate Analgesia During Urgent Endovascular Treatment of Critical Limb Ischemia with Resting Pain

Authors: Derya Tureli, Sinan Deniz, Aytekin Unlukaplan, Levent Oguzkurt

Published in: CardioVascular and Interventional Radiology | Issue 1/2018

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Abstract

Purpose

To demonstrate feasibility and safety of ultrasound-guided popliteal sciatic nerve block for providing analgesia during urgent endovascular treatment of critical limb ischemia with resting pain.

Materials and Methods

Ultrasound-guided popliteal sciatic blocks were performed by an interventional radiologist in angiography suite immediately prior to commencement of urgent endovascular treatment of 30 critical limb ischemia patients. Subjective pain levels prior to and following sciatic block were assessed using the visual analog scale (VAS). Need for any supplemental anxiolytics or analgesics during treatment was recorded. Post-procedural evaluation of patient and operator satisfaction levels regarding the intervention was also documented.

Results

Ultrasound-guided sciatic block provided adequate analgesia in all patients; VAS scores were 0 (no pain) in 87% and 1–3 (mild to annoying pain) in 13%. Two patients required anxiolytic premedication. Additional analgesia was not required during course of endovascular treatment of any patients. Time necessary to perform sciatic block ranged 3–9 (mean 5.9 ± 1.3) min. Median number of needle attempts was 1 (range 1–3). Onset of satisfactory block ranged from 5 to 20 min (mean 9.4 ± 2.6 min). Mean treatment time was 102.2 ± 36.7 min, and balloon time was 22.4 ± 6.1 min. Patient and operator satisfaction with pain control were very good in all cases. There were no procedure-related complications.

Conclusions

Ultrasound-guided popliteal sciatic block is a feasible and safe alternative for providing adequate analgesia during urgent endovascular treatment of critical limb ischemia with resting pain.

Level of Evidence

Level 4, case series.
Literature
1.
Marcus AJ, Lotzof K, Kamath BS, et al. A new approach: regional nerve blockade for angioplasty of the lower limb. Cardiovasc Intervent Radiol. 2006;29:235–40.CrossRefPubMed
2.
Liu SS, Strodtbeck WM, Richman JM, Wu CL. A comparison of regional versus general anesthesia for ambulatory anesthesia: a meta-analysis of randomized controlled trials. Anesth Analg. 2005;101:1634–42.CrossRefPubMed
3.
Kent ML, Hackworth RJ, Riffenburgh RH, et al. A comparison of ultrasound-guided and landmark-based approaches to saphenous nerve blockade: a prospective, controlled, blinded, crossover trial. Anesth Analg. 2013;117:265–70.CrossRefPubMed
4.
McCartney CJ, Lin L, Shastri U. Evidence basis for the use of ultrasound for upper-extremity blocks. Reg Anesth Pain Med. 2010;35:S10–5.CrossRefPubMed
5.
Neal JM, Mulroy MF, Weinberg GL. American society of regional anesthesia and pain medicine checklist for managing local anesthetic systemic toxicity: 2012 version. Reg Anesth Pain Med. 2012;37:16–8.CrossRefPubMed
6.
Moran TC, Kaye AD, Mai AH, Bok LR. Sedation, analgesia, and local anesthesia: a review for general and interventional radiologists. Radiographics. 2013;33:E47–60.CrossRefPubMed
7.
Neal JM. Ultrasound-guided regional anesthesia and patient safety: update of an evidence-based analysis. Reg Anesth Pain Med. 2016;41:195–204.CrossRefPubMed
8.
Sermeus L, Pirson A, Breebaart B, et al. Clinical guidelines for the practice of peripheral nerve blocks in the adult. Acta Anaesthesiol Belg. 2013;64:105–8.PubMed
9.
Lehman MA, Lind LJ. Sedation, analgesia, and anesthesia. In: Kandarpa K, Machan L, Durham J, editors. Handbook of interventional radiologic procedures. Philadelphia: Wolters Kluwer; 2016. p. 590–600.
10.
Perlas A, Brull R, Chan VW, McCartney CJ, Nuica A, Abbas S. Ultrasound guidance improves the success of sciatic nerve block at the popliteal fossa. Reg Anesth Pain Med. 2008;33:259–65.CrossRefPubMed
11.
Mariano ER, Loland VJ, Sandhu NS, et al. Comparative efficacy of ultrasound-guided and stimulating popliteal-sciatic perineural catheters for postoperative analgesia. Can J Anaesth. 2010;57:919–26.CrossRefPubMedPubMedCentral
12.
Dufour E, Quennesson P, Van Robais AL, et al. Combined ultrasound and neurostimulation guidance for popliteal sciatic nerve block: a prospective, randomized comparison with neurostimulation alone. Anesth Analg. 2008;106:1553–8.CrossRefPubMed
13.
Danelli G, Fanelli A, Ghisi D, et al. Ultrasound vs nerve stimulation multiple injection technique for posterior popliteal sciatic nerve block. Anaesthesia. 2009;64:638–42.CrossRefPubMed
14.
Bendtsen TF, Nielsen TD, Rohde CV, Kibak K, Linde F. Ultrasound guidance improves a continuous popliteal sciatic nerve block when compared with nerve stimulation. Reg Anesth Pain Med. 2011;36:181–4.CrossRefPubMed
15.
Bang SU, Kim DJ, Bae JH, Chung K, Kim Y. Minimum effective local anesthetic volume for surgical anesthesia by subparaneural, ultrasound-guided popliteal sciatic nerve block: a prospective dose-finding study. Medicine. 2016;95:e4652.CrossRefPubMedPubMedCentral
16.
Latzke D, Marhofer P, Zeitlinger M, et al. Minimal local anaesthetic volumes for sciatic nerve block: evaluation of ED 99 in volunteers. Br J Anaesth. 2010;104:239–44.CrossRefPubMed
17.
Keplinger M, Marhofer P, Marhofer D, et al. Effective local anaesthetic volumes for sciatic nerve blockade: a clinical evaluation of the ED99. Anaesthesia. 2015;70:585–90.CrossRefPubMed
18.
Metadata
Title
Ultrasound-Guided Popliteal Sciatic Block Provides Adequate Analgesia During Urgent Endovascular Treatment of Critical Limb Ischemia with Resting Pain
Authors
Derya Tureli
Sinan Deniz
Aytekin Unlukaplan
Levent Oguzkurt
Publication date
01-01-2018
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology / Issue 1/2018
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-017-1802-2

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