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

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.