Continuous sciatic nerve block as preoperative care for lower-limb revascularization surgery

Abstract

Background The prevalence of peripheral arterial disease increases with age and it is highly prevalent (15–20%) over 70 years. Surgery can be the best option to resolve the disabling pain. The Anesthesiology and Acute Pain Service routinely adopts continuous popliteal nerve-analgesic block as preoperative care. Patients and methods This case series analyzes the medical records of patients under continuous ultrasound-guided sciatic block, during 2 years (2017–2018) before lower-limb revascularization surgery. From a total number of 25 records identified, 15 were selected for analysis. The primary outcome was pain relief from basal line to 24 h postcatheter placement, measured by the Numerical Rating Pain Scale, and the secondary outcomes were reduction of Numerical Pain Rating Scale after 72 h, complications, and possible technical difficulties. Results We found pain reduction in the first 24 h of catheter placement, with median Numerical Rating Pain Scale reduction from 10 [interquartile range (IIQ) 10–10] to 0 (IIQ 0–2) (P<0.001); and from 0 to 72 h of catheter placement, with Numerical Rating Pain Scale decreasing median from 10 (IIQ 10–9) to 2 (IIQ 0–2) (P<0.0001). Four (26.7%) patients had their catheters displaced, and in another four (26.7%) patients, hyperemia was observed around the catheter’s introduction ostium on the skin. Conclusion Preoperative continuous sciatic nerve block seems to be an effective and safe approach for pain management of peripheral vascular occlusive disease patients waiting for surgery.